title: Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity.
abstract: OBJECTIVE
  To test the hypothesis that the outcome of patients with ventilator-associated pneumonia (VAP) depends on both their baseline severity at VAP onset and the adequacy of empirical antibiotic therapy.
  
  
  METHODS
  Prospective clinical study in six intensive care units in Paris, France.
  
  
  METHODS
  One hundred and forty-two patients with VAP after >/= 48 h of mechanical ventilation.
  
  
  RESULTS
  Patients were compared according to whether adequate antibiotics were started when VAP was first suspected (D0). At day 0, the rate of adequate antibiotic therapy was 44.4% and rose to 92% at day 2. Outcomes were recorded at the ICU and hospital discharge. Overall, no significant mortality difference was found with and without adequate early antibiotics. When patients were also classified based on the initial Logistic Organ Dysfunction score (LOD), mortality was significantly higher with inadequate early antibiotic therapy in the groups with LOD </= 4 (ICU mortality: 37% vs 7%, P=0.006; hospital mortality: 44% vs 15%, P=0.01). A multivariate logistic regression confirmed that inadequate antibiotic therapy increased mortality in patients with LOD </= 4 after adjustment on other prognostic factors.
  
  
  CONCLUSIONS
  Inadequate empirical treatment seemed to be associated with a poor prognosis only in patients with LOD </= 4. These results need to be confirmed by further studies before any reappraisal of current guidelines for empirical antibiotic therapy of VAP can be envisaged.
authors.affiliation: Medical and Surgical ICU, Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Route de Stalingrad, 93009, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Clec'h
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Arnaud
authors.initials: A
authors.lastname: De Lassence
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Maite
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvilier
authors.forename: Gilles
authors.initials: G
authors.lastname: Troche
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.forename: Olivier
authors.initials: O
authors.lastname: Tuil
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents