• Douglas F Willson, Michelle Hoot, Robinder Khemani, Christopher Carrol, Aileen Kirby, Adam Schwarz, Rainer Gedeit, Sholeen T Nett, Simon Erickson, Heidi Flori, Spencer Hays, Mark Hall, and Ventilator-Associated INfection (VAIN) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network.
• 1Division of Pediatric Critical Care, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.2Division of Pediatric Critical Care, Children's Hospital of Los Angeles, Los Angeles, CA.3Division of Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT.4Division of Pediatric Critical Care, Doernbecher Children's Hospital, Portland, OR.5Division of Pediatric Critical Care, Children's Hospital of Orange County, Orange, CA.6Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI.7Division of Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.8Division of Pediatric Critical Care, Princess Margaret Hospital, Perth, Australia.9Division of Pediatric Critical Care, C. S. Mott Children's Hospital of the University of Michigan, Ann Arbor, MI.10Department of Statistical Science and Operations Research, Virginia Commonwealth University, Richmond, VA.11Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, OH.
• Pediatr Crit Care Me. 2017 Jan 1; 18 (1): e24-e34.

ObjectiveSuspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes.DesignProspective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia. Two hundred twenty-nine pediatric patients ventilated more than 48 hours undergoing respiratory secretion cultures were enrolled as "suspected ventilator-associated infection" in a prospective cohort study, those receiving antibiotics of less than or equal to 3 days were categorized as "evaluation only," and greater than 3 days as "treated." Demographics, diagnoses, comorbidities, culture results, and clinical data were compared between evaluation only and treated subjects and between subjects with positive versus negative cultures.SettingPICUs in 47 hospitals in the United States, Canada, and Australia.SubjectsAll patients undergoing respiratory secretion cultures during the 6 study periods.InterventionsNone.Measurements And Main ResultsTreated subjects differed from evaluation-only subjects only in frequency of positive cultures (79% vs 36%; p < 0.0001). Subjects with positive cultures were more likely to have chronic lung disease, tracheostomy, and shorter PICU stay, but there were no differences in ventilator days or mortality. Outcomes were similar in subjects with positive or negative cultures irrespective of antibiotic treatment. Immunocompromise and higher Pediatric Logistic Organ Dysfunction scores were the only variables associated with mortality in the overall population, but treated subjects with endotracheal tubes had significantly lower mortality.ConclusionsPositive respiratory cultures were the primary determinant of continued antibiotic treatment in children with suspected ventilator-associated infection. Positive cultures were not associated with worse outcomes irrespective of antibiotic treatment although the lower mortality in treated subjects with endotracheal tubes is notable. The necessity of continuing antibiotics for a positive respiratory culture in suspected ventilator-associated infection requires further study.

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