Enteral antipseudomonal fluoroquinolones for ventilator-associated tracheobronchitis in children with pre-existing tracheostomy.

ABSTRACT

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.