Ventilator-Associated Tracheitis in Children: Does Antibiotic Duration Matter?

Tamma, Pranita D.; Turnbull, Alison E.; Milstone, Aaron M.; Lehmann, Christoph U.; Sydnor, Emily; Cosgrove, Sara E.

doi:10.1093/cid/cir203

Cited by 61 publications

(72 citation statements)

References 27 publications

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“…33 Antibiotic duration as short of 6 days has been shown to adequately treat ventilatorassociated tracheitis and prevent subsequent development of pneumonia. 34 There are very few data to support a specific duration of antibiotic therapy for children with community-acquired pneumonia, let alone PBB. 35 Although…”

Section: Featurementioning

confidence: 99%

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Bidiwala¹,

Krilov²,

Pirzada³

et al. 2015

Pediatr Ann

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Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterial infection of conducting airways defined by the presence of cough for longer than 4 weeks that resolves with antimicrobial therapy and without an alternative diagnosis. The diagnosis is made by the findings of increased bronchial secretions and edema of the lower airways on flexible bronchoscopy and positive cultures on bronchoalveolar lavage. It is speculated that an initial respiratory insult such as viral infection disrupts normal surface morphology and ciliary function, which leads to chronic self-perpetuating inflammation with the formation of bacterial biofilms, leading to PBB. PBB is often misdiagnosed as asthma, leading to inappropriate and excessive use of steroids. The importance of timely diagnosis should be emphasized due to the potential that PBB may be a precursor to chronic suppurative lung disease or bronchiectasis if left untreated; however, every patient should be adequately assessed to exclude other causes of chronic cough.Con: Clinical criteria for the diagnosis of PBB are nonspecific and may not distinguish it from other known causes of chronic cough, including viral infections. Benefits from antibiotic therapy (particularly prolonged therapy) have not been demonstrated. Respiratory conditions are the most common reason for antibiotic prescriptions during ambulatory visits in the United States, and many of these prescriptions are inappropriate and/or unnecessary. The proposed diagnostic criteria and recommendations for the treatment of PBB will lead to unnecessary overuse of antibiotics.

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Section: Featurementioning

confidence: 99%

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Bidiwala¹,

Krilov²,

Pirzada³

et al. 2015

Pediatr Ann

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“…3,4 The optimal treatment duration for urinary tract infection (UTI) in ambulatory, noncatheterized women is well defined. 5 In contrast, the optimal treatment duration for UTI in men (hereafter, male UTI) is unknown.…”

Section: Uration Of Antimicro-mentioning

confidence: 99%

“…In other infectious diseases, including cellulitis, 11 ventilator-associated pneumonia, 4 and ventilator-associated tracheitis, 3 shorter-duration treatment seems to be as effective as longer-duration treatment and yields less colonization and infection with…”

Section: Uration Of Antimicro-mentioning

confidence: 99%

“…Both studies address questions about the field of UTI in which the existing literature is insufficient to guide clinical management. The full article, 3 entitled "Urinary Tract Infection in Male Veterans: Treatment Patterns and Outcomes," focuses on the appropriate duration of antibiotic therapy for outpatient male veterans with UTI. This retrospective study used administrative data and International Classification of Diseases, Ninth Revision codes to examine outpatient male UTI, with attention to whether shorter duration (Յ7 days) or longer duration (Ͼ7 days) of antibiotic therapy was prescribed.…”

Section: Invited Commentarymentioning

confidence: 99%

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Urinary Tract Infection in Male Veterans

Drekonja¹,

Rector²,

Cutting³

et al. 2013

JAMA Intern Med

120

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Background: Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.Methods: Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (Ͻ30 days), or late recurrence (Ն30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.Results: Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorterduration treatment (Յ7 days), and 65.0% of patients received longer-duration treatment (Ͼ7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P Ͻ .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longerduration vs shorter-duration treatment (0.5% vs 0.3%, P =.02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07). Conclusion:Longer-duration treatment (Ͼ7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.

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“…21 Multidrug resistant Gram-negative (MDRGN) organisms were defined as organisms not susceptible (resistant or intermediate) to at least 1 agent in at least 3 of 6 antimicrobial drug classes, including aminoglycosides, anti-pseudomonal penicillins, third-generation cephalosporins, anti-pseudomonal fluoroquinolones, aztreonam, orcarbapenems. 22 Escherichia coli and Klebsiella spp were identified as extended spectrum b-lactamase (ESBL) producing when there was an increase in the zone of inhibition of $5 mm with either ceftazidime or cefotaxime discs when tested in combination with discs containing clavulanic acid. 23 Enterobacteriaceae resistant to ertapenem and ceftriaxone and positive by the Modified Hodge Test were reported as carbapenamase producers.…”

Section: Data Collectionmentioning

confidence: 99%

Empiric Combination Therapy for Gram-Negative Bacteremia

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:Existing data do not demonstrate a need for combination therapy after antimicrobial susceptibility data indicate adequate in vitro activity with b-lactam monotherapy. However, the role of empirical combination therapy for the treatment of Gram-negative bacteremia in children remains unsettled. WHAT THIS STUDY ADDS:We conducted a retrospective, propensityscore matched study demonstrating no improvement in 10-day mortality of children who have Gram-negative bacteremia receiving empirical b-lactam and aminoglycoside combination therapy compared with b-lactam monotherapy, unless the bacteremic episode was attributable to a multidrug-resistant organism. METHODS:We conducted a retrospective cohort study of children treated for Gram-negative bacteremia at The Johns Hopkins Hospital from 2004 through 2012. We compared the estimated odds of 10-day mortality and the relative duration of bacteremia for children receiving empirical combination therapy versus empirical monotherapy using 1:1 nearest-neighbor propensity-score matching without replacement, before performing regression analysis. RESULTS:We identified 226 matched pairs of patients well balanced on baseline covariates. Ten-day mortality was similar between the groups (odds ratio, 0.84; 95% confidence interval [CI], 0.28 to 1.71). Use of empirical combination therapy was not associated with a decrease in the duration of bacteremia (20.51 days; 95% CI, 22.22 to 1.48 days). There was no survival benefit when evaluating 10-day mortality for the severely ill (pediatric risk of mortality III score $15) or profoundly neutropenic patients (absolute neutrophil count #100 cells/mL) receiving combination therapy. However, a survival benefit was observed when empirical combination therapy was prescribed for children growing multidrug-resistant Gram-negative organisms from the bloodstream (odds ratio, 0.70; 95% CI, 0.51 to 0.84). CONCLUSIONS:Although there appears to be no advantage to the routine addition of an aminoglycoside to a b-lactam as empirical therapy for children who have Gram-negative bacteremia, children who have risk factors for MDRGN organisms appear to benefit from this practice.

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Ventilator-Associated Tracheitis in Children: Does Antibiotic Duration Matter?

Abstract: A prolonged course of antibiotics for VAT does not appear to protect against progression to HAP or VAP compared with short-course therapy. Furthermore, prolonged antibiotic courses were associated with a significantly increased risk of subsequent MDRO acquisition.

Cited by 61 publications

References 27 publications

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Pro-Con Debate: Protracted Bacterial Bronchitis as a Cause of Chronic Cough in Children

Urinary Tract Infection in Male Veterans

Empiric Combination Therapy for Gram-Negative Bacteremia

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