Methods: This retrospective stewardship evaluation between 1/2009 and 7/2016 was conducted in a 12-bed PICU. Antibiotic choice and DOT were at the physicians’ discretion. VAT was defined by signs and symptoms and positive sputum (≥moderate polymorphonuclear cells and ≥moderate NLFGNR growth) without radiographic findings. Primary outcomes were rate of microbiologically documented or clinically suspected (CS) pulmonary infection recurrence and emergence of resistance (≥4 increase in minimal inhibitory concentration) or MDRO within 30 days of VAT treatment. Thirty-day readmission and in-hospital mortality were also assessed.
Results: Fifty patients were included (PCG n=27, SCG n=23). Median age was 1.6 years (0-18.8), PIM2 score was 1 (0.1-82.8), 62% of patients had a tracheostomy at baseline, 70% had P. aeruginosa, and these were comparable between groups. More patients in PCG vs SCG (44% vs 13%, P=0.03) had an admission diagnosis of respiratory failure. Mechanical ventilation (12.5 vs 5 days, P<0.01) and PICU stay (16 vs 6 days, P<0.01) were longer in PCG vs SCG. Median DOT was 10 (8-30) in PCG vs 6 days (3-7) in SCG, with β-lactams as the common agents and no difference in combination therapy (33% vs 13%, P=0.1). Clinical response at the end of treatment was 89% in PCG and 100% in SCG, P=0.2. Recurrence was 26% in PCG and 9% (all CS) in SCG, P=0.2 at 17 days (1-29) and 9.5 days (4-15) P=0.5, respectively. Emergence of resistance or MDRO occurred in 15% in PCG vs 0% in SCG, P=0.1. Readmission and in-hospital mortality were 7% vs 9%, P=0.9 and 7% vs 0%, P=0.5 in PCG and SCG, respectively.
Conclusion: In this small cohort of PICU patients with NLFGNR VAT, there was no microbiologically documented recurrence and emergence of resistance or MDRO in SCG compared to PCG. Our findings suggest that short DOT may be considered for children who are less sick including those with a tracheostomy at baseline.
J. Lighter-Fisher, None
J. Papadopoulos, None
Y. Dubrovskaya, None