Variability in antimicrobial use in pediatric ventilator-associated events

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Clinical pharmacology

Background:

• Ventilator-associated events (VAEs) are common in critically ill children.
• Antimicrobial use for VAEs varies significantly, impacting patient outcomes and resistance.
• Effective antimicrobial stewardship is crucial for optimizing treatment in pediatric intensive care units (PICUs).

Purpose of the Study:

• To evaluate the variability in antimicrobial prescribing for pediatric VAEs.
• To examine the association between antimicrobial use and infection testing in VAEs.
• To identify opportunities for antimicrobial stewardship interventions.

Main Methods:

• Retrospective cohort study with a nested case-control design.
• Analysis of data from 6 US hospitals across PICUs, CICUs, and NICUs.
• Inclusion of children (≤18 years) ventilated for at least one day, identified using established criteria for VAEs, antimicrobial use (AVACs), and possible pneumonia (PVAP).

Main Results:

• Of 9,025 ventilated children, 192 had VAEs; 79 (41%) met AVAC criteria.
• Antimicrobial use (AVACs) and spectrum varied by ICU type and hospital, with CICUs and PICUs more frequently using broad-spectrum agents.
• Only 39% of AVAC cases had respiratory infection testing, identifying PVAP in 15 cases; 73% of AVAC cases lacked positive diagnostic tests.

Conclusions:

• Antimicrobial use is prevalent in pediatric VAEs, but often not supported by diagnostic evidence of infection.
• Significant variability exists in antimicrobial prescribing practices across different pediatric intensive care settings.
• The high rate of antimicrobial use without confirmed infection in AVAC cases presents a key target for antimicrobial stewardship programs.