Faculty Collaboration Database

Development of an Antibiotic Guideline for Children With Suspected Ventilator-Associated Infections. Pediatr Crit Care Med 2019 Aug;20(8):697-706

Date

04/16/2019

Pubmed ID

30985606

DOI

10.1097/PCC.0000000000001942

Scopus ID

2-s2.0-85071348420 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

OBJECTIVES: To develop a guideline for the decision to continue or stop antibiotics at 48-72 hours after their initiation in children with suspected ventilator-associated infection.

DESIGN: Prospective, multicenter observational data collection and subsequent development of an antibiotic guideline.

SETTING: Twenty-two PICUs.

PATIENTS: Children less than 3 years old receiving mechanical ventilation who underwent clinical testing and initiation of antibiotics for suspected ventilator-associated infection.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Phase 1 was a prospective data collection in 281 invasively ventilated children with suspected ventilator-associated infection. The median age was 8 months (interquartile range, 4-16 mo) and 75% had at least one comorbidity. Phase 2 was development of the guideline scoring system by an expert panel employing consensus conferences, literature search, discussions with institutional colleagues, and refinement using phase 1 data. Guideline scores were then applied retrospectively to the phase 1 data. Higher scores correlated with duration of antibiotics (p < 0.001) and higher PEdiatric Logistic Organ Dysfunction 2 scores (p < 0.001) but not mortality, PICU-free days or ventilator-free days. Considering safety and outcomes based on the phase 1 data and aiming for a 25% reduction in antibiotic use, the panel recommended stopping antibiotics at 48-72 hours for guideline scores less than or equal to 2, continuing antibiotics for scores greater than or equal to 6, and offered no recommendation for scores 3, 4, and 5. The acceptability and effect of these recommendations on antibiotic use and outcomes will be prospectively tested in phase 3 of the study.

CONCLUSIONS: We developed a scoring system with recommendations to guide the decision to stop or continue antibiotics at 48-72 hours in children with suspected ventilator-associated infection. The safety and efficacy of the recommendations will be prospectively tested in the planned phase 3 of the study.

Author List

Shein SL, Karam O, Beardsley A, Karsies T, Prentice E, Tarquinio KM, Willson DF, Pediatric Acute Lung Injury and Sepsis Investigator (PALISI) Network

Author

Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Consensus Development Conferences as Topic
Drug Administration Schedule
Female
Humans
Infant
Intensive Care Units, Pediatric
Male
Pneumonia, Ventilator-Associated
Practice Guidelines as Topic
Prospective Studies
Respiration, Artificial