Olivier Leroy1, Agnès Meybeck2, Thibaud d'Escrivan2, Patrick Devos3, Eric Kipnis2, Hugues Georges2. 1. Service de Réanimation Médicale et Maladies Infectieuses, Hôpital G. Chatiliez, Université de Lille, 135 rue du Président Coty, 59208, Tourcoing, France. oleroy@ch-tourcoing.fr. 2. Service de Réanimation Médicale et Maladies Infectieuses, Hôpital G. Chatiliez, Université de Lille, 135 rue du Président Coty, 59208, Tourcoing, France. 3. Département de biostatistiques, CERIM CHRU Lille, 1 Place de Verdun, 59045, Lille Cedex, France.
Abstract
OBJECTIVE: To study the prognostic impact of the appropriateness of initial antimicrobial therapy in patients suffering from ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Observational cohort from January 1994 to December 2001 in one intensive care unit (ICU) from an university-affiliated, urban teaching hospital. PATIENTS: All 132 consecutive patients exhibiting bacteriologically documented VAP during ICU stay. MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40% vs. 62%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.
OBJECTIVE: To study the prognostic impact of the appropriateness of initial antimicrobial therapy in patients suffering from ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Observational cohort from January 1994 to December 2001 in one intensive care unit (ICU) from an university-affiliated, urban teaching hospital. PATIENTS: All 132 consecutive patients exhibiting bacteriologically documented VAP during ICU stay. MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40% vs. 62%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.
Authors: Serdar Akca; Philip Haji-Michael; Arnaldo de Mendonça; Peter Suter; Marcel Levi; Jean Louis Vincent Journal: Crit Care Med Date: 2002-04 Impact factor: 7.598
Authors: A H Froon; M J Bonten; C A Gaillard; J W Greve; M A Dentener; P W de Leeuw; M Drent; E E Stobberingh; W A Buurman Journal: Am J Respir Crit Care Med Date: 1998-10 Impact factor: 21.405
Authors: Edward Abraham; Peter Andrews; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Michael Pinsky; Peter Radermacher; Marco Ranieri; Christian Richard; Robert Tasker; Benoît Vallet Journal: Intensive Care Med Date: 2004-05-15 Impact factor: 17.440
Authors: Frédéric Garcin; Marc Leone; François Antonini; Aude Charvet; Jacques Albanèse; Claude Martin Journal: Intensive Care Med Date: 2009-09-24 Impact factor: 17.440
Authors: Andre C Kalil; Mark L Metersky; Michael Klompas; John Muscedere; Daniel A Sweeney; Lucy B Palmer; Lena M Napolitano; Naomi P O'Grady; John G Bartlett; Jordi Carratalà; Ali A El Solh; Santiago Ewig; Paul D Fey; Thomas M File; Marcos I Restrepo; Jason A Roberts; Grant W Waterer; Peggy Cruse; Shandra L Knight; Jan L Brozek Journal: Clin Infect Dis Date: 2016-07-14 Impact factor: 9.079
Authors: José Garnacho-Montero; C Ortiz-Leyba; Esteban Fernández-Hinojosa; Teresa Aldabó-Pallás; Aurelio Cayuela; Juan A Marquez-Vácaro; Andrés Garcia-Curiel; F J Jiménez-Jiménez Journal: Intensive Care Med Date: 2005-03-23 Impact factor: 17.440