Respiratory Secretion Analyses in the Evaluation of Ventilator-Associated Pneumonia

Willson, Douglas F.; Kirby, Aileen; Kicker, Jennifer S.

doi:10.1097/pcc.0000000000000213

Cited by 31 publications

(21 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of guidance is evident in the variable practice described in a recent survey of pediatric intensivists by Willson et al (16). The inconsistency in care is also supported by our finding that there was no difference in the rate of patients receiving 4 or more days of antibiotics, at about 70%, whether or not a VAI definition was met.…”

Section: Discussionsupporting

confidence: 85%

An Evaluation of Various Ventilator-Associated Infection Criteria in a PICU*

Beardsley

Nitu

Cox

et al. 2016

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

There is little overlap in diagnosis of various ventilator-associated infection. However, the risk factors and outcomes associated with individual criteria are similar, indicating that they may have validity in identifying true pathology. Ventilator-associated infection in general is likely a larger problem than indicated by low hospital-reported rates of ventilator-associated pneumonia. There is clinical confusion due to the presence of several diagnostic criteria for ventilator-associated infection. Developing a more inclusive and clinically relevant criterion for diagnosing ventilator-associated infection is warranted to accurately assess their impact and improve guidance for clinicians in evaluating and treating ventilator-associated infection.

show abstract

Section: Discussionsupporting

confidence: 85%

An Evaluation of Various Ventilator-Associated Infection Criteria in a PICU*

Beardsley

Nitu

Cox

et al. 2016

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Our hazard model was consistent with other analyses that showed longer intubation time as a risk factor for VAI, [17][18][19][20][21][22][23][24] and our time-dependent analysis showed a fourfold increase in incidence of HAIS for every day that an ETT was present. Pulmonary infections occurred in 68% of mechanically ventilated subjects, which are extremely high but consistent with some previous reports.…”

Section: Discussionsupporting

confidence: 91%

Presence of Invasive Devices and Risks of Healthcare-Associated Infections and Sepsis

Bennett

VanBuren

Holubkov

et al. 2018

J Pediatr Intensive Care

View full text Add to dashboard Cite

The present study evaluated the daily risk of healthcare-associated infections and sepsis (HAIS) events in pediatric intensive care unit patients with invasive devices. This was a retrospective cohort study. Invasive devices were associated with significant daily risk of HAIS (p < 0.05). Endotracheal tubes posed the greatest risk of HAIS (hazard ratio [HR]: 4.39, confidence interval [CI]: 2.59–7.46). Children with both a central venous catheter (CVC) and urinary catheter (UC) had over 2.5-fold increased daily risk (HR: 2.59, CI: 1.18–5.68), in addition to daily CVC risk (HR: 3.06, CI: 1.38–6.77) and daily UC risk (HR: 8.9, CI: 3.62–21.91). We conclude that a multistate hazard model optimally predicts daily HAIS risk.

show abstract

“…While the study protocol did not mandate antibiotic treatment, subjects diagnosed with LRI received, on average, more than double the number of antibiotics relative to subjects intubated without nosocomial infection. This behavior is consistent with a recently reported survey of pediatric intensivists (10) and is illustrative of why suspected ventilator-associated infection is the most common reason for antibiotic use in the PICU (2). …”

Section: Discussionsupporting

confidence: 91%

Diagnosis and Treatment of Ventilator-Associated Infection

Willson

Webster

Heidemann

et al. 2016

Pediatric Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

Objective The Critical Illness Stress-Induced Immune Suppression (CRISIS) Prevention Trial was a randomized, masked trial of zinc, selenium, glutamine and metoclopramide compared to whey protein in delaying nosocomial infection in pediatric intensive care unit (PICU) patients. One fourth of study subjects were diagnosed with nosocomial lower respiratory infection (LRI), which contributed to subjects receiving antibiotics 74% of all patient days in the PICU. We analyzed diagnostic and treatment variability among the participating institutions and compared outcomes between nosocomial LRI subjects (n=74) and intubated subjects without nosocomial infection (n=155). Design Post-hoc analysis Setting Eight hospitals in the Collaborative Pediatric Critical Care Research Network Patients CRISIS study subjects. Interventions None Measurements and Main Results Variability across institutions existed in the frequency and manner by which respiratory secretion cultures were obtained, processed and results reported. Most results were reported semi-quantitatively and both Gram stains and antibiotic sensitivities were frequently omitted. The nosocomial LRI diagnosis was associated with increased PICU lengths of stay compared to those who were intubated without nosocomial infection (24±19 vs 9±6 days; p<0.001) and antibiotic use (38±29 vs. 15±20 antibiotics days; p<0.001). Despite antibiotic treatment, the same bacteria persisted in 45% of follow-up cultures. Conclusions The CRISIS data demonstrate that the nosocomial LRI diagnosis is associated with longer lengths of stay and increased antibiotic use, but there is considerable diagnostic and treatment variability across institutions. More rigorous standards for when and how respiratory cultures are obtained, processed, and reported are necessary. Bacterial persistence also complicates the interpretation of follow-up cultures.

show abstract

Respiratory Secretion Analyses in the Evaluation of Ventilator-Associated Pneumonia

Cited by 31 publications

References 24 publications

An Evaluation of Various Ventilator-Associated Infection Criteria in a PICU*

An Evaluation of Various Ventilator-Associated Infection Criteria in a PICU*

Presence of Invasive Devices and Risks of Healthcare-Associated Infections and Sepsis

Diagnosis and Treatment of Ventilator-Associated Infection

Contact Info

Product

Resources

About