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.

Figure 1.

Study design of ventilator-associated tracheitis (VAT) in the neonatal and pediatric intensive care units between 1 January 2007 and 31 December 2009.

Figure 2.

Cumulative distribution function of hospital-acquired pneumonia (HAP), shown for 118 children who met the definition of ventilator-associated tracheitis (VAT). P = .46, by log-rank test.

Figure 3.

Cumulative distribution function of colonization or infection with a multidrug-resistant organism (MDRO), shown for 150 children receiving antibiotic therapy for ventilator-associated tracheitis (VAT). P ≤ .01, by log-rank test.