Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia

The Journal of Trauma
Eric W MuellerTimothy C Fabian

Abstract

Using an arbitrary day cutoff or clinical signs to decide the duration of antibiotic therapy for ventilator-associated pneumonia (VAP) may be suboptimal for some patients. We sought to determine whether antibiotic duration for VAP can be safely abbreviated in trauma patients using repeat bronchoalveolar lavage (BAL). This was an observational case-controlled pilot study. Fifty-two patients were treated for VAP using a repeat BAL clinical pathway. Definitive antibiotic therapy for VAP was discontinued if pathogen growth was <10,000 colony forming units/mL on repeat BAL performed on day 4 of antibiotic therapy (responder), otherwise therapy was continued per managing team. A matched control group of 52 VAP patients treated before (immediately consecutive) the pathway was used for comparison. Antibiotic duration in pathway patients was shorter than control patients (9.8 days +/- 3.8 days vs. 16.7 days +/- 7.4 days; p < 0.001), including nonfermenting gram-negative bacilli VAP (10.7 days +/- 4.1 days vs. 14.4 days +/- 4.2 days; p < 0.001). There were no differences in pneumonia relapse, mechanical ventilator-free intensive care unit (ICU) days, ICU-free hospital days, or mortality. Of study group isolates, 86 (82.7%) responded on r...Continue Reading

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Citations

Sep 30, 2009·Surgical Infections·Joseph M SwansonTimothy C Fabian
Jan 23, 2013·Critical Care : the Official Journal of the Critical Care Forum·Ignacio Martin-Loeches, Antoni Torres
Oct 5, 2010·Drugs·Jean-Louis VincentSilvia Cianferoni
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Oct 1, 2011·Expert Review of Respiratory Medicine·Todd F Huzar, James M Cross

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