title: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.
abstract: BACKGROUND
  The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown. Shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care unit (ICU).
  
  
  OBJECTIVE
  To determine whether 8 days is as effective as 15 days of antibiotic treatment of patients with microbiologically proven VAP.
  
  
  METHODS
  Prospective, randomized, double-blind (until day 8) clinical trial conducted in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP by quantitative culture results of bronchoscopic specimens and who had received initial appropriate empirical antimicrobial therapy were enrolled between May 1999 and June 2002.
  
  
  METHODS
  A total of 197 patients were randomly assigned to receive 8 days and 204 to receive 15 days of therapy with an antibiotic regimen selected by the treating physician.
  
  
  METHODS
  Primary outcome measures-death from any cause, microbiologically documented pulmonary infection recurrence, and antibiotic-free days-were assessed 28 days after VAP onset and analyzed on an intent-to-treat basis.
  
  
  RESULTS
  Compared with patients treated for 15 days, those treated for 8 days had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence interval [CI], -3.7% to 6.9%) nor more recurrent infections (28.9% vs 26.0%; difference, 2.9%; 90% CI, -3.2% to 9.1%), but they had more mean (SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P<.001). The number of mechanical ventilation-free days, the number of organ failure-free days, the length of ICU stay, and mortality rates on day 60 for the 2 groups did not differ. Although patients with VAP caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when antimicrobial therapy lasted only 8 days, they did have a higher pulmonary infection-recurrence rate compared with those receiving 15 days of treatment (40.6% vs 25.4%; difference, 15.2%, 90% CI, 3.9%-26.6%). Among patients who developed recurrent infections, multiresistant pathogens emerged less frequently in those who had received 8 days of antibiotics (42.1% vs 62.0% of pulmonary recurrences, P =.04).
  
  
  CONCLUSIONS
  Among patients who had received appropriate initial empirical therapy, with the possible exception of those developing nonfermenting gram-negative bacillus infections, comparable clinical effectiveness against VAP was obtained with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic use.
authors: Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
authors: Jean
authors: J
authors: Chastre
authors: Michel
authors: M
authors: Wolff
authors: Jean-Yves
authors: JY
authors: Fagon
authors: Sylvie
authors: S
authors: Chevret
authors: Franck
authors: F
authors: Thomas
authors: Delphine
authors: D
authors: Wermert
authors: Eva
authors: E
authors: Clementi
authors: Jesus
authors: J
authors: Gonzalez
authors: Dominique
authors: D
authors: Jusserand
authors: Pierre
authors: P
authors: Asfar
authors: Dominique
authors: D
authors: Perrin
authors: Fabienne
authors: F
authors: Fieux
authors: Sylvie
authors: S
authors: Aubas
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001999:Bronchoscopy; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents