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Published on: January 22, 2021
Duration of antibiotic therapy for pediatric ventilator-associated pneumonia
Aki Miyashita1, Hanako Funakoshi1, Meiwa Shibata1
1Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
A six to seven-day antibiotic course for pediatric ventilator-associated pneumonia (VAP) appears safe and effective. Outcomes in children were comparable or better than adult VAP treatment data.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Optimal antibiotic duration for pediatric ventilator-associated pneumonia (VAP) is not well-established.
- Adult VAP guidelines recommend a seven-day antibiotic course.
- This study focuses on pediatric VAP management and outcomes.
Purpose of the Study:
- To describe the treatment and clinical outcomes of pediatric VAP.
- To evaluate the effectiveness of current VAP management strategies in children.
- To compare pediatric VAP outcomes with existing adult data.
Main Methods:
- Retrospective cohort study in a Pediatric Intensive Care Unit (PICU).
- Included children under 18 diagnosed with VAP (CDC criteria) from April 2016 to June 2023.
- Excluded patients with co-infections or no prior antibiotic therapy; collected demographic and microbiological data.
Main Results:
- Ninety pediatric patients were analyzed; median age was 19 months.
- Staphylococcus aureus (28%) and Pseudomonas aeruginosa (22%) were common pathogens.
- Median antibiotic duration was six days; 7-day and 28-day mortality rates were 1% and 6%, respectively, with no VAP-related deaths. Recurrence rate was 10%.
Conclusions:
- A six to seven-day antibiotic regimen for pediatric VAP is associated with favorable outcomes.
- Pediatric VAP recurrence rates and recovery metrics (ventilation-free, PICU-free days) were comparable or superior to adult data.
- Current antibiotic treatment durations for pediatric VAP appear adequate.
Background:
Although a seven-day course of antibiotic therapy for ventilator-associated pneumonia (VAP) is recommended for adult patients, the optimal duration in children remains unclear. Our study described the management of pediatric VAP by focusing on the treatment and clinical outcomes.
Methods:
We performed a retrospective cohort study in the Pediatric Intensive Care Unit (PICU) of a tertiary children's hospital. Children under 18 diagnosed with VAP between April 2016 and June 2023 were included. VAP was defined by the Centers for Disease Control and Prevention of the United States criteria. Exclusion criteria included co-infections or a lack of prior antibiotic therapy. Demographic and microbiological data were collected from medical records.
Results:
Ninety patients were eligible for enrollment. The median age was 19 months (IQR: 10-69 months) and 44% were girls. The median pediatric index of mortality-2 score was 4 (IQR: 1.3-8.6). Staphylococcus aureus was the most frequently isolated pathogen (28%), followed by Pseudomonas aeruginosa (22%). The median length of antibiotic therapy was six days (IQR: 6-7 days). Mortality on days 7 and 28 was 1% (n = 1) and 6% (n = 5), without VAP-related deaths. The recurrence rate was 10% (n = 9). The median ventilation-free and PICU-free days at day 28 were 22 and 17, respectively.
Conclusion:
Most patients received a six to seven-day course of antibiotic therapy without adverse outcomes. The recurrence rate and the ventilation-free and PICU-free days were equivalent to or better than those reported previously for adults.
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