Systematic Endotracheal Aspiration in the Pediatric Intensive Care Unit Reduces Broad-spectrum Antibiotic Use for Ventilator-associated Pneumonia.

Abstract

To determine the impact of a systematic endotracheal aspiration (ETA) sampling program for mechanically ventilated patients on initial antibiotic therapy for ventilator-acquired pneumonia (VAP). Retrospective cohort study; before-after study design. Pediatric intensive care unit (PICU) with 16 medical and surgical beds in a tertiary teaching hospital. Patients <16 years of age hospitalized in the PICU who fulfilled VAP criteria. Biweekly systematic ETA sampling was conducted in mechanically ventilated patients. We retrospectively studied patients who received antibiotic therapy for suspected VAP 12 months before and after the initiation of systematic ETA (periods 1 and 2, respectively), evaluating the initial antibiotic therapy spectrum in both periods. During period 1, 56 patients developed VAP and 47 developed VAP during period 2. The incidence was 17 cases of VAP/1000 days of mechanical ventilation in both periods. Ideal antibiotic therapy was prescribed in 19.6% of cases for period 1 and 55.2% for period 2 (P = 0.001). Initial antibiotic therapy for VAP during period 2 had a significantly lower proportion of broad-spectrum antibiotics than therapy during period 1 (P = 0.01). In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP.