PURPOSE: The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: This was a secondary analysis from a multicenter trial of 740 patients with suspected VAP randomized tobronchoscopy or endotracheal aspirate cultures; all received empirical broad-spectrum antibiotics. Patients were grouped by whether they received TT, defined as tailoring or discontinuing antibiotics in response to enrolment culture results. RESULTS: For patients with a positive culture (n = 412), baseline demographics, clinical progression of infection and multiple organ dysfunction scores (MODS), and mortality were similar for those on TT (n = 320) or those who did not receive TT (NoTT) (n = 92). The TT group had more days alive and off broad-spectrum antibiotics (14.5 vs 13.2, P = .04). In patients with a negative culture (n = 327), those on TT (n = 230) had similar baseline demographics, less frequent final adjudicated diagnosis of VAP (63.0% vs 76.3%, P = .02), and less severe clinical progression of infection and MODS compared with NoTT (n = 97). The TT group had more days alive and off broad-spectrum antibiotics (15.9 vs 13.1, P < .001), lower delta MODS (2.0 vs 3.0, P = .01), fewer mechanical ventilation days (9.8 vs 14.7, P = .03), and similar mortality compared to NoTT. CONCLUSIONS: Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
RCT Entities:
PURPOSE: The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: This was a secondary analysis from a multicenter trial of 740 patients with suspected VAP randomized to bronchoscopy or endotracheal aspirate cultures; all received empirical broad-spectrum antibiotics. Patients were grouped by whether they received TT, defined as tailoring or discontinuing antibiotics in response to enrolment culture results. RESULTS: For patients with a positive culture (n = 412), baseline demographics, clinical progression of infection and multiple organ dysfunction scores (MODS), and mortality were similar for those on TT (n = 320) or those who did not receive TT (NoTT) (n = 92). The TT group had more days alive and off broad-spectrum antibiotics (14.5 vs 13.2, P = .04). In patients with a negative culture (n = 327), those on TT (n = 230) had similar baseline demographics, less frequent final adjudicated diagnosis of VAP (63.0% vs 76.3%, P = .02), and less severe clinical progression of infection and MODS compared with NoTT (n = 97). The TT group had more days alive and off broad-spectrum antibiotics (15.9 vs 13.1, P < .001), lower delta MODS (2.0 vs 3.0, P = .01), fewer mechanical ventilation days (9.8 vs 14.7, P = .03), and similar mortality compared to NoTT. CONCLUSIONS: Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
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: Alexis Tabah; Matteo Bassetti; Marin H Kollef; Jean-Ralph Zahar; José-Artur Paiva; Jean-Francois Timsit; Jason A Roberts; Jeroen Schouten; Helen Giamarellou; Jordi Rello; Jan De Waele; Andrew F Shorr; Marc Leone; Garyphallia Poulakou; Pieter Depuydt; Jose Garnacho-Montero Journal: Intensive Care Med Date: 2019-11-28 Impact factor: 17.440
Authors: Liesbet De Bus; Pieter Depuydt; Johan Steen; Sofie Dhaese; Ken De Smet; Alexis Tabah; Murat Akova; Menino Osbert Cotta; Gennaro De Pascale; George Dimopoulos; Shigeki Fujitani; Jose Garnacho-Montero; Marc Leone; Jeffrey Lipman; Marlies Ostermann; José-Artur Paiva; Jeroen Schouten; Fredrik Sjövall; Jean-François Timsit; Jason A Roberts; Jean-Ralph Zahar; Farid Zand; Kapil Zirpe; Jan J De Waele Journal: Intensive Care Med Date: 2020-06-09 Impact factor: 17.440