Methods
This retrospective cohort study was approved by the Institutional Review Board at Loma Linda University Children’s Health. Pediatric patients less than 18 years of age with an artificial airway who received at least five days of enteral ciprofloxacin or levofloxacin for treatment of VAT between January 2013 and January 2020 were included.
Data collected through medical record review included patient demographics, length of hospital admission, primary diagnosis, comorbidities, and presence and duration of tracheostomy and/or intubation. Antibiotic dosing, culture data including susceptibility results, inflammatory markers, respiratory viral panel results, chest radiography, and secretion description were also collected. For the purpose of analysis, antibiotic susceptibility results reported as “intermediate” were considered to not provide appropriate antimicrobial coverage. The following pathogens were considered nonpathogenic: Group B Streptococcus , Neisseria saprophyticus , Streptococcus viridans , coagulase-negativeStaphylococcus. Data was also collected in relation to adverse events including gastrointestinal upset, QT prolongation and QT-prolonging medications, liver function tests and medications that may affect liver function tests, tendonitis and/or tendon rupture, use of seizure rescue medication, and death within 30 days of enteral fluoroquinolone administration. Follow-up provider visits within the healthcare system, rehospitalization for pulmonary infection, and extension of or change in antibiotic course within 30 days of antibiotic course completion were recorded.
The primary endpoint was infection resolution with the use of enteral ciprofloxacin or levofloxacin, as measured by those who did not require a change or extension of antibiotic regimen, initiation of new antibiotic course, or rehospitalization for pulmonary infection within 30 days of completion of antibiotics for VAT. Secondary endpoints included the type and frequency of adverse events. Descriptive statistics were used to describe continuous data. All statistical analyses were performed using Microsoft Excel.