Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial.

Critical Care : the Official Journal of the Critical Care Forum
Jong Wook KimYounsuck Koh

Abstract

Although early use of broad-spectrum antimicrobials in critically ill patients may increase antimicrobial adequacy, uncontrolled use of these agents may select for more-resistant organisms. This study investigated the effects of early use of broad-spectrum antimicrobials in critically ill patients with hospital-acquired pneumonia. We compared the early use of broad-spectrum antimicrobials plus subsequent de-escalation (DE) with conventional antimicrobial treatment (non-de-escalation, NDE) in critically ill patients with hospital-acquired pneumonia (HAP). This open-label, randomized clinical trial was performed in patients in a tertiary-care center medical intensive care unit (MICU) in Korea. Patients (n=54) randomized to the DE group received initial imipenem/cilastatin plus vancomycin with subsequent de-escalation according to culture results, whereas patients randomized to the NDE group (n=55) received noncarbapenem, nonvancomycin empiric antimicrobials. Between November 2004 and October 2006, 109 MICU patients with HAP were enrolled. Initial antimicrobial adequacy was significantly higher in the DE than in the NDE group for Gram-positive organisms (100% versus 14.3%; P<0.001), but not for Gram-negative organisms (64.3% versu...Continue Reading

Associated Clinical Trials

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Citations

Jul 16, 2013·Critical Care : the Official Journal of the Critical Care Forum·Leslie GonzalezSébastien Gibot
Jan 21, 2014·Critical Care : the Official Journal of the Critical Care Forum·Girish B Nair, Michael S Niederman
Dec 26, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alexis TabahJan J De Waele
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Nov 19, 2014·Critical Care : the Official Journal of the Critical Care Forum·Charles-Edouard LuytJean Chastre
Apr 12, 2016·La Presse médicale·Bruno PasteneMarc Leone
Apr 18, 2015·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·E WeissUNKNOWN 'De-escalation' Study Group
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Methods Mentioned

BETA
bronchoalveolar lavage

Software Mentioned

Stata

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