Use of antibiotics in pediatric intensive care and potential savings

Fischer, Joachim E.; Ramser, Meghan; Fanconi, Sergio

doi:10.1007/s001340051288

Cited by 85 publications

(67 citation statements)

References 13 publications

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“…VAP is the most common reason for the initiation of empirical antibiotics among PICU patients. A prospective cohort study at an academic tertiary care center performed in a PICU (n ϭ 456) found that over half (56.6%) of all patients (n ϭ 258) received antibiotics (33). Treatment for suspected VAP comprised 616 of 1,303 (47%) of the antibiotic treatment days.…”

Section: Discussionmentioning

confidence: 99%

“…However, inappropriate use and overuse of antibiotics can lead to increased hospital expenditures and could potentially promote antibiotic resistance (33,83). Empirical antibiotic therapy for suspected VAP accounts for a major proportion of inappropriate antibiotic use in pediatric patients, with up to 33% of patients receiving unwarranted antimicro- Infection with potentially antibiotic-resistant organisms accounts for a large proportion of VAP in adults (95).…”

Section: Empirical Therapymentioning

confidence: 99%

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Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

2007

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SUMMARY Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Empirical Therapymentioning

confidence: 99%

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

2007

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“…Misleading results can lead to inadequate, inappropriate, and delayed antimicrobial therapy, which has been shown to increase mortality, hospital stay, and cost from VAP. 7,10 Therapy for VAP already accounts for ~50% of antibiotic use in PICUs. 11 Prolonged antibiotic use can lead not only to the emergence of multidrug-resistant strains of bacteria in critically ill patients of the PICU but also to increased healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Machado¹,

Webster²

2016

IJN

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Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus , to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x -axis of the tube was similar to previous studies completed for Staphylococcus aureus . Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP.

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“…A similar sample size (56.6%) was used in a one year prospective study of the neonatal ICU at University Children's Hospital, Zurich, Switzerland [16]. Regarding the omission of 2 years (2002 and 2005), a similar approach was used successfully in a 25 year study of emergency surgical admissions where study samples were taken every after 4 years [17].…”

Section: Discussionmentioning

confidence: 99%

Use of the ‘Queuing Theory’ and Patient-Based Characteristics to Assess the Performance of a Paediatric Intensive Care Unit

Wyk¹,

Walubo²

2015

PPIJ

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Use of antibiotics in pediatric intensive care and potential savings

Abstract: In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.

Cited by 85 publications

References 13 publications

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Use of the ‘Queuing Theory’ and Patient-Based Characteristics to Assess the Performance of a Paediatric Intensive Care Unit

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