alexa Ventilator-associated tracheitis in children: does antibiotic duration matter?


Journal of Antimicrobial Agents

Author(s): Tamma PD, Turnbull AE, Milstone AM, Lehmann CU, Sydnor ER,

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Abstract BACKGROUND: The optimal duration of antibiotic therapy for ventilator-associated tracheitis (VAT) has not been defined, which may result in unnecessarily prolonged courses of antibiotics. The primary objective of this study was to determine whether prolonged-course (≥7 days in duration) therapy for VAT was more protective against progression to hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), compared with short-course antibiotics (<7 days in duration). The secondary objective was to determine whether prolonged-course therapy was more likely to result in the acquisition of multidrug-resistant organisms (MDROs) compared with short-course therapy. METHODS: We conducted a retrospective cohort study of children ≤18 years of age hospitalized in the intensive care unit and intubated for ≥48 h from January 2007 through December 2009 who received antibiotic therapy for VAT. RESULTS: Of the 1616 patients intubated for at least 48 h, 150 received antibiotics for clinician-suspected VAT, although only 118 of these patients met VAT criteria. Prolonged-course antibiotics were not protective against subsequent development of HAP or VAP (hazard ratio [HR], 1.08; 95\% confidence interval [CI], 0.40-2.91). Factors associated with subsequent MDRO colonization or infection included prolonged-course antibiotic therapy (HR, 5.15; 95\% CI, 1.54-7.19), receipt of combination antibiotic therapy (HR, 3.24; 95\% CI, 1.54-6.82), and days of hospital exposure prior to completing antibiotic therapy (HR, 1.08; 95\% CI, 1.04-1.12). CONCLUSIONS: A prolonged course of antibiotics for VAT does not appear to protect against progression to HAP or VAP compared with short-course therapy. Furthermore, prolonged antibiotic courses were associated with a significantly increased risk of subsequent MDRO acquisition.
This article was published in Clin Infect Dis and referenced in Journal of Antimicrobial Agents

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