61 - Can we treat for pediatric VAP in the same length of treatment with adults？

Poster Number: 61
Publication Number: 61.1640

Background: Although a seven-day course of antimicrobial therapy for ventilator-associated pneumonia (VAP) was non-inferior to a 14-day course in adults in terms of treatment efficacy, the optimal duration of VAP in children is still understudied.

Objective: The present study aimed to describe the management of pediatric VAP by focusing on the treatment and clinical outcomes.

Design/Methods: The present study prospectively enrolled patients admitted to the pediatric intensive care unit (PICU) at Tokyo Metropolitan Children’s Medical Center between April 1, 2016 and June 30, 2023. The inclusion criteria were age ≦18 years and VAP diagnosed in accordance with the definition of the Centers for Disease Control and Prevention of the United States. The exclusion criteria were pediatric patients treated for other co-infections. Demographic and microbiological data were collected from electronic medical records. The primary outcome was the length of antibiotic treatment. The secondary outcomes were the mortality rate at days 7 and 28 after VAP diagnosis, the recurrence rate, and the duration of ventilation-free days and PICU-free days at day 28 after VAP diagnosis.

Results: Among a total of 114 patients, 90 patients were eligible for enrollment. The median age and percentage of boys was 19 months (IQR: 10-69 months) and 56%, respectively. The median PIM 2 (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%) and Hemophilus influenzae (19%). The underlying diseases were respiratory disorders (56%), congenital heart diseases (47%), and neurological disorders (40%). The median duration of treatment was six days (IQR: 6-7 days). The mortality rate at days 7 and 28 was１％ (one case) and６％ (five cases), respectively. There was no case of VAP-caused mortality. The recurrence rate was 10% (nine cases). The median ventilation-free days and PICU-free days at day 28 after VAP diagnosis was 22 (IQR: 19.5-24.5) and 17 (11.8-22.0), respectively.

Conclusion(s): In the present PICU patient cohort, most of the patients with VAP received a seven-day course of antimicrobial therapy without apparent adverse outcomes.