title: Ventilator-associated tracheitis in children: does antibiotic duration matter?
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.
authors.affiliation: Department of Pediatric Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. ptamma1@jhmi.edu
authors.forename: Pranita D
authors.initials: PD
authors.lastname: Tamma
authors.forename: Alison E
authors.initials: AE
authors.lastname: Turnbull
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
authors.forename: Emily R M
authors.initials: ER
authors.lastname: Sydnor
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D014136:Tracheitis / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents