1264. Infection-related ventilator-associated complications (iVAC) in neonates and children: Can we identify it?
Session: Oral Abstract Session: Device and Procedure Related HAIs
Friday, October 9, 2015: 3:00 PM
Room: 32--ABC

Background: In 2013, three definitions replaced national surveillance for ventilator-associated pneumonia in adults, capturing a range of potential complications that occur during mechanical ventilation. We recently proposed a pediatric and neonatal version of ventilator-associated conditions (VAC), characterized by an increase in daily minimum fraction of inspired oxygen of ≥0.25 or daily minimum mean airway pressure of ≥4 cm H20 for ≥2 days following a period of stability. The objective of this study is to explore definitions for infection-related VAC (iVAC) in neonates and children that are based on the pediatric VAC definition.

Methods: We retrospectively identified consecutive children ≤18 years ventilated for ≥1 day in pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals. The study period varied by hospital based on timing of availability of electronic data; the earliest date was Feb. 2008 and for all hospitals, the study ended July 2013. We identified those patients meeting the proposed pediatric VAC definition and then applied the adult iVAC definition [temperature >38C or <36C, or white blood cell (WBC) count ≥12,000 or ≤4,000 cells/m3, and new antimicrobial use] and variations of that definition. We calculated the proportion of pediatric VAC cases meeting potential criteria for iVAC and examined patient characteristics.

Results: From an overall cohort of 10,209 ventilation episodes, there were 246 pediatric VAC events. Of these, 88% met the adult criteria for abnormal temperature or WBC, with 78-98% meeting the criteria depending on ICU type. When new antimicrobial use was also required, 41% of pediatric VAC events met the adult iVAC definition, with 64% in the CICU, 50% in the PICU, and 19% in the NICU; more stringent temperature and WBC thresholds yielded similar results (see Figure). When we considered the proportion of VAC events meeting the antimicrobial use criterion alone, 42% of VACs met this criterion overall, with 64% in the CICU, 50% in the PICU, and 23% in the NICU.

Conclusion: iVAC rates varied by ICU type and were driven primarily by antimicrobial use. Temperature and WBC count thresholds were not useful in discriminating iVAC in neonates and children.

 

Proportion of pediatric VAC with new antimicrobial use & meeting temperature (degrees C) or WBC (thousands of cells/mm3) thresholds

 

Noelle Cocoros, DSc, MPH1, Thomas J. Sandora, MD, MPH2, Latania K. Logan, MD3, Susan Coffin, MD, MPH, FPIDS4, Gregory P. Priebe, MD2, Julia Shaklee Sammons, MD, MSCE5, Gitte Larsen, MD6, Philip Toltzis, MD7, Kelly Horan, MPH1, Irina Miroshnik, MS1, Michael Burton, BS1, Paul a. Checchia, MD8, Michael Klompas, MD, MPH, FRCPC, FIDSA9 and Grace Lee, MD, MPH, FPIDS1, (1)Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, (2)Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, (3)Pediatrics, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, (4)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Primary Children's Hospital, Salt Lake City, UT, (7)Pediatric Critical Care Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, OH, (8)Texas Children’s Hospital, Houston, TX, (9)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA

Disclosures:

N. Cocoros, None

T. J. Sandora, None

L. K. Logan, None

S. Coffin, None

G. P. Priebe, None

J. S. Sammons, None

G. Larsen, None

P. Toltzis, None

K. Horan, None

I. Miroshnik, None

M. Burton, None

P. A. Checchia, None

M. Klompas, None

G. Lee, None

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