Ventilator-Associated Tracheobronchitis

Craven, Donald E.; Chroneou, Alexandra; Zias, Nikolaos; Hjalmarson, Karin I.

doi:10.1378/chest.08-1617

Cited by 132 publications

(38 citation statements)

References 36 publications

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“…Previous studies have demonstrated the association between VAI and prolongation of ventilation (19,23,26,27). , In this study, subjects diagnosed with LRI had significantly longer durations of intubation even after considering the average five-day time to onset.…”

Section: Discussionmentioning

confidence: 94%

“…Studies in adults have demonstrated similar findings (16,17). The indications for antibiotic treatment in the face of a positive culture are unclear, but antibiotics have not been found to prevent progression from so-called “ventilator-associated tracheitis” to “ventilator-associated pneumonia” (18,19). Indeed, the persistence of positive cultures with the same organism despite appropriate antibiotics in 45% of follow-up cultures in this study demonstrates that antibiotics may not eradicate even sensitive bacteria.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Treatment of Ventilator-Associated Infection

Willson

Webster

Heidemann

et al. 2016

Pediatric Critical Care Medicine

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Ventilator-Associated Infection

Willson

Webster

Heidemann

et al. 2016

Pediatric Critical Care Medicine

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“…Two clinical trials investigating the effect of such treatment have shown lower rates of progression to VAP and decreased duration of mechanical ventilation. [1819] Further prospectively designed studies are required to characterize this entity and establish treatment protocols. The other limitation of our study is the lack of severity of illness score in this cohort of patients which would have enabled us to understand more about the reasons for developing VAT in this group.…”

Section: Discussionmentioning

confidence: 99%

A prospective study of ventilator-associated tracheobronchitis: Incidence and etiology in intensive care unit of a tertiary care hospital

et al. 2017

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“…First, previously we found high negative predictive values of negative SC for the presence of MDR pathogens in HAP [9], allowing a narrower-spectrum antibiotic even in patients with clinical risk factors for MDR. Second, we followed the paradigm that ICU-acquired pneumonia is often preceded by colonization of the upper and lower airways by the same pathogen, going through a possible intermediate stage of ventilator-associated tracheobronchitis [20]. Following Bayes’ theorem, the positive and negative predictive values of SC were then applied to the ATS-IDSA guideline-based clinical risk categories for MDR HAP.…”

Section: Discussionmentioning

confidence: 99%

Development of antibiotic treatment algorithms based on local ecology and respiratory surveillance cultures to restrict the use of broad-spectrum antimicrobial drugs in the treatment of hospital-acquired pneumonia in the intensive care unit: a retrospective analysis

et al. 2014

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IntroductionTimely administration of appropriate antibiotic therapy has been shown to improve outcome in hospital-acquired pneumonia (HAP). Empirical treatment guidelines tailored to local ecology have been advocated in antibiotic stewardship programs. We compared a local ecology based algorithm (LEBA) to a surveillance culture based algorithm (SCBA) in terms of appropriate coverage and spectrum of antimicrobial activity.MethodsWe retrospectively assessed 2 hypothetical empirical antibiotic treatment algorithms for HAP on an existing high-quality prospectively collected database in a mixed 36-bed tertiary intensive care unit (ICU). Data on consecutive episodes of microbiologically confirmed HAP were collected over a period of 40 months and divided in a derivation (1 July 2009 to 31 October 2010) and validation (1 November 2010 until 31 October 2012) cohort. On the derivation cohort we constructed a LEBA, based on overall observed bacterial resistance patterns, and a SCBA, which targeted therapy to surveillance culture (SC) in the individual patient. Therapy was directed against pathogens found in respiratory SC collected two to five days before HAP, and in the absence of these, presence or absence of multi-drug resistant (MDR) pathogens in other SC dictated broad-spectrum, respectively narrow spectrum antibiotic therapy. Subsequently, LEBA and SCBA were retrospectively reviewed and compared with actually prescribed antibiotics in the validation cohort.ResultsThe first 100 HAP episodes made up the derivation cohort and the subsequent 113 HAP episodes the validation cohort. Appropriate antibiotic coverage rates by applying LEBA and SCBA were 88.5% and 87.6%, respectively, and did not differ significantly with respect to appropriateness of the actually prescribed initial therapy (84.1%). SCBA proposed more narrow spectrum therapy as compared to LEBA and the actually prescribed antimicrobials (P <0.001). SCBA recommended significantly less combination therapy and carbapenems compared to LEBA (P <0.001). SCBA targeted antibiotics to recent respiratory SC in 38.1% (43 out of 113 episodes) of HAP; in these cases adequacy was 93% (40 out of 43).ConclusionRates of appropriate antimicrobial coverage were identical in LEBA and SCBA. However, in this setting of moderate MDR prevalence, the use of SCBA would result in a significant reduction of the use of broad-spectrum drugs and may be a preferential strategy when implementing antibiotic stewardship programs.

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Ventilator-Associated Tracheobronchitis

Cited by 132 publications

References 36 publications

Diagnosis and Treatment of Ventilator-Associated Infection

Diagnosis and Treatment of Ventilator-Associated Infection

A prospective study of ventilator-associated tracheobronchitis: Incidence and etiology in intensive care unit of a tertiary care hospital

Development of antibiotic treatment algorithms based on local ecology and respiratory surveillance cultures to restrict the use of broad-spectrum antimicrobial drugs in the treatment of hospital-acquired pneumonia in the intensive care unit: a retrospective analysis

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