(629) Three-Day Antibiotic Duration for Ventilator-Associated Tracheitis in Critically Ill Children

Introduction: Ventilator-associated tracheitis (VAT) is an infectious tracheobronchial inflammation in patients with an artificial airway. There is no consensus on the duration of antibiotic treatment for VAT. Courses as short as 3 days have been reported, but there has been no direct evaluation yet of the possible benefits and clinical outcomes of such short courses. Our primary objective was to determine whether the rate of new multidrug resistant organism (MDRO) acquisition within 31 days is lower in those treated with a 3-day course compared with 5 or more. Our secondary objective was to compare clinical outcomes.

Methods: We conducted a retrospective chart review of VAT treated in the Pediatric Intensive Care Unit (PICU) at a single-center urban tertiary care children’s hospital from September 2021 to April 2024. For repeat infections, only VAT episodes that had antibiotics started greater than 31 days apart from each other for a subject were included. Exclusion criteria included a diagnosis of cystic fibrosis, treatment for another infection, or VAT treatment disrupted by transfer. Demographic data and severity of illness was compared between groups.

Results: One-hundred and twenty-two VAT courses were included, with 38 (31.15%) treated with 3 days of antibiotics. Demographic data was similar between groups. Severity of illness was similar as well, except for a higher mean ± SD Oxygenation Saturation Index (OSI) in the 3-day group (6.9 ± 3.6 vs 5.2 ± 3.2, p=0.01). Overall, we did not find a significant difference in new MDRO acquisition between the two groups (7.9% in the 3-day group vs 14.3% in the 5-day group, p = 0.39). We also did not find a significant difference in rates of progression to VAP, retreatment of VAT, ventilator days above baseline, mortality, hospital and PICU length of stay, and readmission rate between the two groups.

Conclusions: In this retrospective review, there were neither any identified differences in clinical outcomes, nor new MDRO acquisition between a 3-day antibiotic duration for VAT compared to 5 days or more. This suggests that shorter antibiotic courses may be safe and effective for VAT, but further study is needed to validate these findings and clarify any potential benefit in a reduction in new MDRO acquisition.