Ventilator-associated tracheitis in children: Does antibiotic duration matter?

Pranita D. Tamma, Alison E. Turnbull, Aaron M. Milstone, Christoph U. Lehmann, Emily R.M. Sydnor, Sara E. Cosgrove

Research output: Contribution to journalArticle

34 Citations (Scopus)

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). Conclusion s.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.

Original languageEnglish (US)
Pages (from-to)1324-1331
Number of pages8
JournalClinical Infectious Diseases
Volume52
Issue number11
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

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Tracheitis
Mechanical Ventilators
Anti-Bacterial Agents
Ventilator-Associated Pneumonia
Confidence Intervals
Pneumonia
Therapeutics
Intensive Care Units

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Tamma, P. D., Turnbull, A. E., Milstone, A. M., Lehmann, C. U., Sydnor, E. R. M., & Cosgrove, S. E. (2011). Ventilator-associated tracheitis in children: Does antibiotic duration matter? Clinical Infectious Diseases, 52(11), 1324-1331. https://doi.org/10.1093/cid/cir203

Ventilator-associated tracheitis in children : Does antibiotic duration matter? / Tamma, Pranita D.; Turnbull, Alison E.; Milstone, Aaron M.; Lehmann, Christoph U.; Sydnor, Emily R.M.; Cosgrove, Sara E.

In: Clinical Infectious Diseases, Vol. 52, No. 11, 01.06.2011, p. 1324-1331.

Research output: Contribution to journalArticle

Tamma, PD, Turnbull, AE, Milstone, AM, Lehmann, CU, Sydnor, ERM & Cosgrove, SE 2011, 'Ventilator-associated tracheitis in children: Does antibiotic duration matter?', Clinical Infectious Diseases, vol. 52, no. 11, pp. 1324-1331. https://doi.org/10.1093/cid/cir203
Tamma, Pranita D. ; Turnbull, Alison E. ; Milstone, Aaron M. ; Lehmann, Christoph U. ; Sydnor, Emily R.M. ; Cosgrove, Sara E. / Ventilator-associated tracheitis in children : Does antibiotic duration matter?. In: Clinical Infectious Diseases. 2011 ; Vol. 52, No. 11. pp. 1324-1331.
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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). Conclusion s.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.",
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T2 - Does antibiotic duration matter?

AU - Tamma, Pranita D.

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AU - Sydnor, Emily R.M.

AU - Cosgrove, Sara E.

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N2 - 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). Conclusion s.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.

AB - 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). Conclusion s.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.

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