TY - JOUR
T1 - Diagnosis and Treatment of Ventilator-Associated Infection
T2 - Review of the Critical Illness Stress-Induced Immune Suppression Prevention Trial Data
AU - Willson, Douglas F.
AU - Webster, Angela
AU - Heidemann, Sabrina
AU - Meert, Kathleen L.
N1 - Funding Information:
This work was supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS): U10HD050096, U10HD049981, U10HD050009, U10HD049945, U10HD049983, U10HD050012, and U01HD049934.
Publisher Copyright:
© 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objectives: The Critical Illness Stress-Induced Immune Suppression prevention trial was a randomized, masked trial of zinc, selenium, glutamine, and metoclopramide compared with whey protein in delaying nosocomial infection in PICU patients. One fourth of study infjects were diagnosed with nosocomial lower respiratory infection, which contributed to infjects 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 lower respiratory infection infjects (n = 74) and intubated infjects without nosocomial infection (n = 1 55). Design: Post hoc analysis. Setting: Eight hospitals in the Collaborative Pediatric Critical Care Research Network. Patients: Critical Illness Stress-Induced Immune Suppression study infjects. 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 semiquantitatively, and both Gram stains and antibiotic sensitivities were frequently omitted. The nosocomial lower respiratory infection diagnosis was associated with increased PICU lengths of stay compared with those who were intubated without nosocomial infection (24 ± 19 vs 9 ± 6 d; 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 Critical Illness Stress-Induced Immune Suppression data demonstrate that the nosocomial lower respiratory infection 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.
AB - Objectives: The Critical Illness Stress-Induced Immune Suppression prevention trial was a randomized, masked trial of zinc, selenium, glutamine, and metoclopramide compared with whey protein in delaying nosocomial infection in PICU patients. One fourth of study infjects were diagnosed with nosocomial lower respiratory infection, which contributed to infjects 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 lower respiratory infection infjects (n = 74) and intubated infjects without nosocomial infection (n = 1 55). Design: Post hoc analysis. Setting: Eight hospitals in the Collaborative Pediatric Critical Care Research Network. Patients: Critical Illness Stress-Induced Immune Suppression study infjects. 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 semiquantitatively, and both Gram stains and antibiotic sensitivities were frequently omitted. The nosocomial lower respiratory infection diagnosis was associated with increased PICU lengths of stay compared with those who were intubated without nosocomial infection (24 ± 19 vs 9 ± 6 d; 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 Critical Illness Stress-Induced Immune Suppression data demonstrate that the nosocomial lower respiratory infection 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.
KW - hospital-acquired infection
KW - lower respiratory infection
KW - respiratory failure
KW - ventilator-associated infection
UR - http://www.scopus.com/inward/record.url?scp=84958787500&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000000664
DO - 10.1097/PCC.0000000000000664
M3 - Review article
C2 - 26890200
AN - SCOPUS:84958787500
VL - 17
SP - 287
EP - 293
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 4
ER -