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Infect Control Hosp Epidemiol:儿科呼吸机相关事件中抗菌药物使用的变化

发布日期:2019-01-30来源:Infect Control Hosp Epidemiol官网发布人:感控雏鹰

目的

评估抗生素使用的变异性以及与儿科呼吸机相关事件(VAE)中的感染测试的关联。

设计

描述性回顾性队列与巢式病例对照研究。

机构

美国6家医院的儿科重症监护病房(PICU),心脏重症监护室(CICU)和新生儿重症监护病房(NICU)。

患者

儿童≤18岁通风≥1个日历日。

方法

根据先前的建议,我们确定患有儿科呼吸机相关疾病(VAC)的患者,抗生素使用≥4天的儿科VAC(AVAC),以及可能的呼吸机相关性肺炎(PVAP,定义为儿科AVAC,阳性呼吸诊断测试)标准。

结果

在9,025名通气儿童中,我们确定了192例VAC病例,其中43例为CICU,70例为PICU,79例为NICU。79例VAC病例(41%)(58%CICU; 51%PICU; 23%NICU)符合AVAC标准,因医院而异(CICU,20-67%; PICU,0-70%; NICU,0 -43%)。AVAC抗菌药物的类型和持续时间因ICU类型而异。CICU和PICU中的AVAC病例比NICU中的病例更频繁地接受广谱抗菌药物。在AVAC病例中,39%进行了呼吸道感染诊断测试; 在15个VAC案例中确定了PVAP。此外,在AVAC病例中,73%没有相关的阳性呼吸或非呼吸诊断测试。

结论

抗菌药物的使用在儿科VAC中很常见,医院内和ICU类型的抗菌药物的频谱和持续时间各不相同,而PVAP并不常见。虽然PVAP的低比率或感染的实验室检测阳性,但延长抗菌药物的使用表明AVAC可以为抗菌药物管理计划提供杠杆,以提高利用率。

Variability in antimicrobial use in pediatric ventilator-associated events

Objective

To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).

Design

Descriptive retrospective cohort with nested case-control study.

Setting

Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.

Patients

Children≤18 years ventilated for≥1 calendar day.

Methods

We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.

Results

Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.

Conclusions

Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.

简译人:感控雏鹰