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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and
Jessica E Ericson1, John McGuire2, Marian G Michaels3
1From the Penn State College of Medicine, Hershey, Pennsylvania.
Insights
Diagnosing hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) in children is challenging for clinical trials. This study identified key risk factors and epidemiology to improve pediatric HABP/VABP trial efficiency.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Clinical trial methodology
Background:
- Accurate diagnosis of hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) is crucial but challenging for pediatric clinical trials.
- Current diagnostic standards and FDA criteria pose difficulties for efficient and consistent enrollment in antibiotic trials.
- Understanding pediatric-specific risk factors and epidemiology is essential for improving trial design.
Purpose of the Study:
- To identify risk factors associated with the development of HABP/VABP in pediatric intensive and intermediate care unit patients.
- To describe the epidemiology of pediatric HABP/VABP.
- To enhance the efficiency of clinical trials for pediatric HABP/VABP by refining diagnostic criteria and patient selection.
Main Methods:
- Prospective review of electronic medical records for patients under 18 years admitted to ICUs.
- Data abstraction included clinical, laboratory, and imaging findings for patients receiving respiratory support or antibiotics for lower respiratory tract infections/sepsis.
- Multivariable logistic regression was used to identify risk factors for HABP/VABP development.
Main Results:
- Overall incidence of HABP/VABP was 10-12% in the evaluated pediatric ICU population.
- Risk factors for HABP/VABP included increasing age, shorter stature, longer ICU stay, aspiration risk, recent blood transfusion, and frequent suctioning.
- Protective factors against HABP/VABP were identified as noninvasive ventilation and gastric acid suppression.
Conclusions:
- Pediatric HABP/VABP incidence aligns with FDA-defined criteria in 10-12% of ICU admissions.
- Identified risk factors for HABP/VABP vary significantly across different pediatric age groups.
- This research provides valuable insights for optimizing pediatric clinical trial design and patient stratification.
Background:
Clinical trials for antibiotics designed to treat hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) are hampered by making these diagnoses in a way that is acceptable to the United States Food and Drug Administration and consistent with standards of care. We examined laboratory and clinical features that might improve pediatric HABP/VABP trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP.
Methods:
We prospectively reviewed the electronic medical records of patients <18 years of age admitted to intensive and intermediate care units (ICUs) if they received qualifying respiratory support or were started on antibiotics for a lower respiratory tract infection or undifferentiated sepsis. Subjects were followed until HABP/VABP was diagnosed or they were discharged from the ICU. Clinical, laboratory and imaging data were abstracted using structured chart review. We calculated HABP/VABP incidence and used a stepwise backward selection multivariable model to identify risk factors associated with development of HABP/VABP.
Results:
A total of 862 neonates, infants and children were evaluated for development of HABP/VABP; 10% (82/800) of those receiving respiratory support and 12% (103/862) overall developed HABP/VABP. Increasing age, shorter height/length, longer ICU length of stay, aspiration risk, blood product transfusion in the prior 7 days and frequent suctioning were associated with increased odds of HABP/VABP. The use of noninvasive ventilation and gastric acid suppression were both associated with decreased odds of HABP/VABP.
Conclusions:
Food and Drug Administration-defined HABP/VABP occurred in 10%-12% of pediatric patients admitted to ICUs. Risk factors vary by age group.
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