title: Management of Pneumonia in the Pediatric Critical Care Unit: An Area for Antimicrobial Stewardship.
abstract: BACKGROUND
  Pediatric pneumonia is one of the most common causes of childhood infection requiring hospitalization and is a substantial driver of antimicrobial use among hospitalized children. About 12-20% of pediatric patients hospitalized with community-acquired pneumonia (CAP) require critical care. Additionally, nosocomial pneumonias (i.e. hospital-acquired and ventilator- associated pneumonias) are responsible for 15-53% of hospital-associated infections and are the most common indication for empiric antibiotics in the pediatric intensive care unit.
  
  
  OBJECTIVE
  Respiratory infections, especially pneumonias, are a strong area for antimicrobial stewardship program (ASP) interventions, as they have been shown to improve patient outcomes while reducing inappropriate antimicrobial use, antimicrobial resistance, and overall costs.
  
  
  METHODS
  Optimizing the selection of appropriate antimicrobial therapies is difficult for pediatric pneumonias because of the ill-defined definitive diagnostic criteria and difficulty differentiating between viral and bacterial etiology.
  
  
  RESULTS
  The aim of this review is to highlight the role of antimicrobial stewardship efforts in the treatment of pneumonias in critically ill children by discussing the emerging role of diagnostic criteria, the etiology of disease, appropriate targeted antimicrobial selection, and the optimization of antibiotic dosing and pharmacodynamic targets.
authors.affiliation: Department of Pharmacy, Connecticut Children`s Medical Center, Hartford, CT. United States.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Dassner
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102. United States.
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
authors.affiliation: Department of Pharmacy Practice, University of Connecticut, School of Pharmacy, Storrs, CT. United States.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Girotto
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: HAP; PICU; VAP; pediatric antimicrobial stewardship; pediatric pneumonia; pharmacodynamics; severe CAP