Duration of antibiotic therapy for pediatric ventilator-associated pneumonia.

BACKGROUND

Although a seven-day course of antibiotic therapy for ventilator-associated pneumonia (VAP) is recommended for adult patients, the optimal duration in children remains unclear. Our study described the management of pediatric VAP by focusing on the treatment and clinical outcomes.

METHODS

We performed a retrospective cohort study in the Pediatric Intensive Care Unit (PICU) of a tertiary children's hospital. Children under 18 diagnosed with VAP between April 2016 and June 2023 were included. VAP was defined by the Centers for Disease Control and Prevention of the United States criteria. Exclusion criteria included co-infections or a lack of prior antibiotic therapy. Demographic and microbiological data were collected from medical records.

RESULTS

Ninety patients were eligible for enrollment. The median age was 19 months (IQR: 10-69 months) and 44% were girls. The median pediatric index of mortality-2 score was 4 (IQR: 1.3-8.6). Staphylococcus aureus was the most frequently isolated pathogen (28%), followed by Pseudomonas aeruginosa (22%). The median length of antibiotic therapy was six days (IQR: 6-7 days). Mortality on days 7 and 28 was 1% (n = 1) and 6% (n = 5), without VAP-related deaths. The recurrence rate was 10% (n = 9). The median ventilation-free and PICU-free days at day 28 were 22 and 17, respectively.

CONCLUSION

Most patients received a six to seven-day course of antibiotic therapy without adverse outcomes. The recurrence rate and the ventilation-free and PICU-free days were equivalent to or better than those reported previously for adults.