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

Abstract

Aim: 

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).

Design: 

Retrospective cohort study; before-after study design.

Setting: 

Pediatric intensive care unit (PICU) with 16 medical and surgical beds in a tertiary teaching hospital.

Subjects: 

Patients <16 years of age hospitalized in the PICU who fulfilled VAP criteria.

Intervention: 

Biweekly systematic ETA sampling was conducted in mechanically ventilated patients.

Measurements: 

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.

Results: 

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).

Conclusion: 

In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP.