Pediatric Ventilator-Associated Infections: The Ventilator-Associated INfection Study.
Suspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes.



Prospective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia. Two hundred twenty-nine pediatric patients ventilated more than 48 hours undergoing respiratory secretion cultures were enrolled as "suspected ventilator-associated infection" in a prospective cohort study, those receiving antibiotics of less than or equal to 3 days were categorized as "evaluation only," and greater than 3 days as "treated." Demographics, diagnoses, comorbidities, culture results, and clinical data were compared between evaluation only and treated subjects and between subjects with positive versus negative cultures.



PICUs in 47 hospitals in the United States, Canada, and Australia.



All patients undergoing respiratory secretion cultures during the 6 study periods.



None.



Treated subjects differed from evaluation-only subjects only in frequency of positive cultures (79% vs 36%; p < 0.0001). Subjects with positive cultures were more likely to have chronic lung disease, tracheostomy, and shorter PICU stay, but there were no differences in ventilator days or mortality. Outcomes were similar in subjects with positive or negative cultures irrespective of antibiotic treatment. Immunocompromise and higher Pediatric Logistic Organ Dysfunction scores were the only variables associated with mortality in the overall population, but treated subjects with endotracheal tubes had significantly lower mortality.



Positive respiratory cultures were the primary determinant of continued antibiotic treatment in children with suspected ventilator-associated infection. Positive cultures were not associated with worse outcomes irrespective of antibiotic treatment although the lower mortality in treated subjects with endotracheal tubes is notable. The necessity of continuing antibiotics for a positive respiratory culture in suspected ventilator-associated infection requires further study.
1Division of Pediatric Critical Care, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.2Division of Pediatric Critical Care, Children's Hospital of Los Angeles, Los Angeles, CA.3Division of Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT.4Division of Pediatric Critical Care, Doernbecher Children's Hospital, Portland, OR.5Division of Pediatric Critical Care, Children's Hospital of Orange County, Orange, CA.6Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI.7Division of Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.8Division of Pediatric Critical Care, Princess Margaret Hospital, Perth, Australia.9Division of Pediatric Critical Care, C. S. Mott Children's Hospital of the University of Michigan, Ann Arbor, MI.10Department of Statistical Science and Operations Research, Virginia Commonwealth University, Richmond, VA.11Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, OH.
Douglas F
DF
Willson
Michelle
M
Hoot
Robinder
R
Khemani
Christopher
C
Carrol
Aileen
A
Kirby
Adam
A
Schwarz
Rainer
R
Gedeit
Sholeen T
ST
Nett
Simon
S
Erickson
Heidi
H
Flori
Spencer
S
Hays
Mark
M
Hall
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001315:Australia; D002170:Canada; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D004334:Drug Administration Schedule; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents