174. Treatment of Tracheitis and Antimicrobial Stewardship Interventions

BACKGROUND: Antibiotics are commonly overused in the treatment of ventilator-associated tracheitis (VAT). Antimicrobial stewardship programs (ASP) optimize antibiotic prescribing and decrease unnecessary antibiotic use. At our institution, clinicians who have initiated antibiotics for the treatment of tracheitis do not agree with ASP recommendations in 35% of cases. The goal of this study was to compare antibiotic duration and treatment failure in children treated for VAT who did and did not receive an ASP recommendation. METHODS: We performed a retrospective cohort study to evaluate VAT treatment courses and subsequent treatment failures. For this study, we included all children who were hospitalized from January 2009 to February 2013 and reviewed by ASP for receiving a monitored drug with an indication of VAT. Treatment failure was defined as a patient requiring a repeat course of antibiotics with an indication of VAT within 14 days of completing a previous antibiotic course. RESULTS: A total of 220 VAT cases were included. ASP provided recommendations to optimize antibiotics in 44 cases (20%) and stop antibiotics in 53 cases (24%). The shortest duration of treatment (days) was prescribed when ASP recommended stop therapy (median 4.7, IQR 3.0–6.5) when compared with no intervention (6.0, 4.3–7.0; P = 0.01). Treatment failure occurred in 33 (15%) cases. No difference in antibiotic duration was observed between those who did or did not fail (6.3 vs. 5.9, respectively; P = 0.11). Additionally, treatment failure rates did not differ by ASP recommendation status (no recommendation 15%; optimize 18%; stop 11%; ID involved 20%; P = 0.78). CONCLUSION: ASP recommendations for the treatment of pediatric VAT were not associated with an increased likelihood of treatment failure. Further work is needed to standardize the diagnosis and treatment of VAT to avoid unnecessary antibiotic use in these children. DISCLOSURES: All authors: No reported disclosures.