Smith Christina J, Sierra Caroline M, Robbins Joanna, Cobbina Ekua
Department of Pharmacy, Loma Linda University Children's Hospital, Loma Linda, California, USA.
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA.
Pediatr Pulmonol. 2022 Apr;57(4):1064-1071. doi: 10.1002/ppul.25816. Epub 2022 Jan 17.
Pseudomonas aeruginosa is the most commonly isolated organism in tracheostomy-dependent children with ventilator-associated tracheobronchitis (VAT). Enteral treatment with an antipseudomonal fluoroquinolone such as ciprofloxacin or levofloxacin is sometimes employed, but supportive data are limited. The purpose of this study was to evaluate the effectiveness and safety of enteral antipseudomonal fluoroquinolones for VAT in children with pre-existing tracheostomy.
This was a retrospective review of electronic medical records for tracheostomy-dependent children <18 years of age who received an enteral antipseduomonal fluoroquinolone for the treatment of presumed VAT from January 2013 through January 2020 at an academic children's hospital.
Seventy-six treatment courses representing 60 children (median age: 9.5, interquartile range [IQR]: 3.6-13.1 years) received an antipseudomonal fluoroquinolone for VAT treatment during the study period. Median treatment duration was 8 (range: 7-10) days. Most tracheostomy cultures (n = 70/82, 85%) were polymicrobial, with P. aeruginosa most commonly isolated (n = 67/224 organisms, 30%). Sixty-five courses (86%) were successfully treated with an enteral fluoroquinolone. Antibiotics were changed or extended for two (3%) children. Antibiotics were prescribed for 10 (13%) courses and eight (11%) required hospitalization for a respiratory infection within 30 days of fluoroquinolone completion. Six (8%) courses received a seizure rescue medication, seven (9%) experienced emesis, and one (1%) had elevated transaminases. Tendonitis and tendon rupture were not observed.
The results of this study suggest enteral antipseudomonal fluoroquinolones may be effective for the treatment of VAT in children with tracheostomy. Further study is warranted to clarify the role of these agents in pediatric VAT.
铜绿假单胞菌是依赖气管造口术的儿童呼吸机相关性气管支气管炎（VAT）中最常分离出的病原体。有时会采用抗假单胞菌氟喹诺酮类药物（如环丙沙星或左氧氟沙星）进行肠内治疗，但支持性数据有限。本研究的目的是评估肠内抗假单胞菌氟喹诺酮类药物对已有气管造口术的儿童VAT的有效性和安全性。
这是一项对2013年1月至2020年1月在一家学术儿童医院接受肠内抗假单胞菌氟喹诺酮类药物治疗疑似VAT的18岁以下依赖气管造口术儿童的电子病历进行的回顾性研究。
在研究期间，代表60名儿童（中位年龄：9.5岁，四分位间距[IQR]：3.6 - 13.1岁）的76个疗程接受了抗假单胞菌氟喹诺酮类药物治疗VAT。中位治疗持续时间为8（范围：7 - 10）天。大多数气管造口术培养物（n = 70/82，85%）为多种微生物感染，其中铜绿假单胞菌最常被分离出（n = 67/224种微生物，30%）。65个疗程（86%）通过肠内氟喹诺酮类药物成功治疗。两名（3%）儿童的抗生素被更换或延长使用。10个疗程（13%）使用了抗生素，8个疗程（11%）在氟喹诺酮类药物治疗结束后30天内因呼吸道感染需要住院治疗。6个疗程（8%）接受了癫痫抢救药物治疗，7个疗程（9%）出现呕吐，1个疗程（1%）转氨酶升高。未观察到肌腱炎和肌腱断裂。
本研究结果表明，肠内抗假单胞菌氟喹诺酮类药物可能对气管造口术儿童的VAT治疗有效。有必要进一步研究以阐明这些药物在儿童VAT中的作用。
