Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity.
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.
Clec'h
Christophe
C
Medical and Surgical ICU, Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Route de Stalingrad, 93009, Bobigny, France.
Timsit
Jean-François
JF
De Lassence
Arnaud
A
Azoulay
Elie
E
Alberti
Corinne
C
Garrouste-Orgeas
Maite
M
Mourvilier
Bruno
B
Troche
Gilles
G
Tafflet
Muriel
M
Tuil
Olivier
O
Cohen
Yves
Y
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
D000900:Anti-Bacterial Agents