Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia.

Intensive Care Medicine
Boris JungSamir Jaber

Abstract

Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP. Retrospective analysis of prospectively collected data in a medical-surgical intensive care unit (ICU) of a university hospital. We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA-BAL (concordant group), discordant EA-BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups. Ninety assessable EA-BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P < 0.05) to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate. No significant differ...Continue Reading

References

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Citations

Jun 13, 2009·The Journal of Antimicrobial Chemotherapy·Ali A El Solh, Ahmad Alhajhusain
Nov 2, 2011·Burns : Journal of the International Society for Burn Injuries·Nele BrusselaersStijn Blot
Feb 13, 2015·Critical Care : the Official Journal of the Critical Care Forum·Christian Brun-Buisson
Jun 17, 2015·Intensive Care Medicine·Cédric BretonnièreUNKNOWN Société Française d’Anesthésie et de Réanimation (SFAR)
Jun 15, 2010·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Noyal Mariya JosephSubhash Chandra Parija
Oct 17, 2016·Enfermedades infecciosas y microbiología clínica·Emilio BouzaUNKNOWN “Diagnóstico Etiológico de la Neumonía Asociada a Ventilación Mecánica (DENEVEM)” – Etiologic diagnosis of VAP – Study Group
Jun 10, 2009·Current Opinion in Infectious Diseases·Emilio Bouza, Almudena Burillo
Jan 24, 2014·Current Opinion in Infectious Diseases·Carlos M LunaAlejandro Raimondi
Mar 13, 2014·Current Opinion in Pulmonary Medicine·Johannes B J ScholteCatharina F M Linssen

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