1887

Abstract

The optimal duration of the treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1 week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10 to 14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital’s intensive care units between 1 January and 31 December 2015. Duration of antibiotic therapy was determined with 5 day clinical evaluation according to previously established criteria. Patients were divided into two groups depending on length of treatment, short (7–10 days) and long treatment (>10 days). Nineteen patients received 7 to 10 day antibiotic therapy, and 30 received >10 day antibiotic therapy. Demographic and clinical characteristics, Glasgow Coma Scale score, CPIS and the PaO/FiO ratio at the time of diagnosis of VAP were statistically similar between the two groups (>0.05). A second VAP attack occurred post-treatment in three patients receiving short-term treatment and in four receiving long-term treatment (=0.561). The numbers of antibiotic-free days were 15.6±6.2 in the short-term treatment group and 8.3±7.5 in the long-term group (<0.0001). One of the patients receiving short-term treatment died within 28 days after treatment, and four of the patients receiving long-term treatment (=0.348) did so. The most commonly observed micro-organisms in both groups were and . Short-term treatment can be administered in cases with early clinical and laboratory response started on VAP treatment by considering individual characteristics and monitoring fever, CPIS, the PaO/FiO ratio, C-reactive protein and procalcitonin values.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000401
2017-01-01
2020-09-25
Loading full text...

Full text loading...

/deliver/fulltext/jmm/66/1/78.html?itemId=/content/journal/jmm/10.1099/jmm.0.000401&mimeType=html&fmt=ahah

References

  1. Guillamet CV, Kollef MH. Ventilator associated pneumonia in the ICU: where has it gone?. Curr Opin Pulm Med 2015;21:226–231 [CrossRef][PubMed]
    [Google Scholar]
  2. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013;13:665–671 [CrossRef][PubMed]
    [Google Scholar]
  3. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012;33:250–256 [CrossRef][PubMed]
    [Google Scholar]
  4. Niederman MS, Craven DE. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416 [CrossRef][PubMed]
    [Google Scholar]
  5. Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J Crit Care 2008;23:91–100 [CrossRef][PubMed]
    [Google Scholar]
  6. Martin-Loeches I, Torres A. A week seems to be weak: tailoring duration of antibiotic treatment in Gram-negative ventilator-associated pneumonia. Crit Care 2013;17:106 [CrossRef][PubMed]
    [Google Scholar]
  7. Silva CD, Silva Júnior M. Strategies for appropriate antibiotic use in intensive care unit. Einstein 2015;13:448–453 [CrossRef][PubMed]
    [Google Scholar]
  8. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332 [CrossRef][PubMed]
    [Google Scholar]
  9. Luyt CE, Chastre J, Fagon JY. Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia. Intensive Care Med 2004;30:844–852 [CrossRef][PubMed]
    [Google Scholar]
  10. Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care 2011;56:1087–1094 [CrossRef][PubMed]
    [Google Scholar]
  11. Wolfensberger A, Sax H, Weber R, Zbinden R, Kuster SP et al. Change of antibiotic susceptibility testing guidelines from CLSI to EUCAST: influence on cumulative hospital antibiograms. PLoS One 2013;8:e79130 [CrossRef][PubMed]
    [Google Scholar]
  12. Alp E, Damani N. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries 2015;9:1040–1045[PubMed][CrossRef]
    [Google Scholar]
  13. Kollef MH. Optimizing antibiotic therapy in the intensive care unit setting. Crit Care 2001;5:189–195[PubMed][CrossRef]
    [Google Scholar]
  14. Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discov Today Technol 2014;11:33–39 [CrossRef][PubMed]
    [Google Scholar]
  15. Niederman MS. Principles of appropriate antibiotic use. Int J Antimicrob Agents 2005;26:S170–S175[PubMed][CrossRef]
    [Google Scholar]
  16. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588–2598 [CrossRef][PubMed]
    [Google Scholar]
  17. Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH et al. Short-vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 2013;144:1759–1767 [CrossRef][PubMed]
    [Google Scholar]
  18. Pugh R, Grant C, Cooke RP, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev 2011;CD007577
    [Google Scholar]
  19. Capellier G, Mockly H, Charpentier C, Annane D, Blasco G et al. Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment. PLoS One 2012;7:e41290 [CrossRef][PubMed]
    [Google Scholar]
  20. American Thoracic Society Documents Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416 [CrossRef][PubMed]
    [Google Scholar]
  21. Kollef MH, Chastre J, Clavel M, Restrepo MI, Michiels B et al. A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin for ventilator-associated pneumonia. Crit Care 2012;16:R218 [CrossRef][PubMed]
    [Google Scholar]
  22. Helmy TA, Shehata SA, Noiem RS. Short course versus long-course antibiotic therapy for ventilator associated pneumonia. Am J Res Commun 2015;3:111–122
    [Google Scholar]
  23. Fekih Hassen M, Ayed S, Ben Sik Ali H, Gharbi R, Marghli S et al. [Duration of antibiotic therapy for ventilator-associated pneumonia: comparison of 7 and 10 days. A pilot study]. Ann Fr Anesth Reanim 2009;28:16–23 [CrossRef][PubMed]
    [Google Scholar]
  24. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–1596 [CrossRef][PubMed]
    [Google Scholar]
  25. Nseir S, Martin-Loeches I, Makris D, Jaillette E, Karvouniaris M et al. Impact of appropriate antimicrobial treatment on transition from ventilator-associated tracheobronchitis to ventilator-associated pneumonia. Crit Care 2014;18:R129 [CrossRef][PubMed]
    [Google Scholar]
  26. Taccone FS, Bond O, Cavicchi FZ, Hites M. Individualized antibiotic strategies. Curr Opin Anaesthesiol 2016;29:166–171 [CrossRef][PubMed]
    [Google Scholar]
  27. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008;177:498–505 [CrossRef][PubMed]
    [Google Scholar]
  28. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis 2013;26:140–150 [CrossRef][PubMed]
    [Google Scholar]
  29. Craven DE, Hjalmarson KI. Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clin Infect Dis 2010;51:S59–S66 [CrossRef][PubMed]
    [Google Scholar]
  30. Rodríguez A, Póvoa P, Nseir S, Salluh J, Curcio D. et al. Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey. Crit Care 2014;18:R32 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000401
Loading
/content/journal/jmm/10.1099/jmm.0.000401
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error