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.