A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia.
OBJECTIVE
To evaluate an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia (VAP).


METHODS
Prospective, randomized, controlled clinical trial.


METHODS
A medical ICU from a university-affiliated urban teaching hospital.


METHODS
Between April 2002 and July 2003, 290 patients completed the clinical trial.


METHODS
Patients were assigned to have the duration of antibiotic treatment for VAP determined by an antibiotic discontinuation policy (discontinuation group) or their treating physician teams (conventional group).


RESULTS
Severity of illness using APACHE (acute physiology and chronic health evaluation) II score (22.8 +/- 9.0 vs 23.2 +/- 9.4, p = 0.683) [mean +/- SD] and the clinical pulmonary infection score (7.1 +/- 0.9 vs 7.2 +/- 0.9, p = 0.222) were similar for both patient groups. The duration of antibiotic treatment for VAP was statistically shorter among patients in the discontinuation group compared to patients in the conventional antibiotic management group (6.0 +/- 4.9 days vs 8.0 +/- 5.6 days, p = 0.001). The occurrence of a secondary episode of VAP was not statistically different between these two groups (17.3% vs 19.3%, p = 0.667). Hospital mortality (32.0% vs 37.1%, p = 0.357) and ICU length of stay (6.8 +/- 6.1 days vs 7.0 +/- 7.3 days, p = 0.798) were also statistically similar.


CONCLUSIONS
The application of an antibiotic discontinuation policy for clinically suspected VAP was associated with a decrease in the overall duration of antibiotic treatment. These findings suggest that shorter courses of empiric antibiotic therapy for patients treated for clinically suspected VAP can be safely achieved.
Micek
Scott T
ST
Department of Pharmacy, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA.
Ward
Suzanne
S
Fraser
Victoria J
VJ
Kollef
Marin H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D000900:Anti-Bacterial Agents