Systematic endotracheal aspiration cuts antibiotic use for ventilator-related pneumonia

Being aware of bronchial colonization results in a decreased use of initial broad-spectrum antibiotic for ventilator-associated pneumonia (VAP) in the paediatric intensive care unit (PICU), reports a recent study.

This retrospective cohort study, with a before-after design, was conducted at a PICU in a tertiary teaching hospital to determine the impact of a systematic endotracheal aspiration (ETA) sampling program for mechanically ventilated patients on initial antibiotic therapy for VAP.

Patients aged <16 years hospitalized in the PICU who fulfilled VAP criteria were included. Biweekly systematic ETA sampling was performed in mechanically ventilated patients. The researchers examined patients on antibiotics for suspected VAP 12 months before and after the initiation of systematic ETA (periods 1 and 2, respectively), and assessed the initial antibiotic therapy spectrum in both periods.

Fifty-six patients developed VAP during period 1 and 47 during period 2. Seventeen cases of VAP per 1,000 days of mechanical ventilation were recorded in both periods.

Ideal antibiotic therapy was prescribed in 19.6 percent and 55.2 percent of cases for periods 1 and 2, respectively (p=0.001). Initial antibiotic therapy for VAP during period 2 showed a markedly lower proportion of broad-spectrum antibiotics compared to therapy during period 1 (p=0.01).

“In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP,” the researchers said.