Duration of antibiotic therapy for ventilator-associated pneumonia caused by non-fermentative gram-negative bacilli.
OBJECTIVE
Chastre et al. compared eight and 15 days of antibiotic therapy for ventilator-associated pneumonia (VAP), finding no difference in outcome with the exception of VAP caused by non-fermentative gram-negative bacilli (NFGNB), for which a higher recurrence rate was seen in the shorter-duration group (JAMA 2003;290:2588-2598). We recently examined our institutional experience with VAP caused by NFGNB to determine whether shorter courses of antibiotic therapy were associated with higher rates of recurrence.


METHODS
Data collected on all patients completing treatment for VAP in a surgical/trauma intensive care unit from December 1996 to October 2004 were analyzed retrospectively for the relations between the duration of antibiotic therapy and recurrence and in-hospital mortality rates.


RESULTS
Of the 452 episodes of VAP, 154 were associated with NFGNB. Twenty-seven patients were treated with 3-8 days (mean 6.4 +/- 0.3 days) of antibiotics, whereas 127 received nine or more days (mean 17.1 +/- 0.7 days) of therapy. The recurrence rate for infections treated with the shorter course was 22% vs. 34% for patients receiving nine or more days of antibiotics (p = 0.27). The mortality rates were 22% and 14%, respectively (p = 0.38). Similar trends were demonstrated for infections caused by other organisms.


CONCLUSIONS
We did not find a higher recurrence rate in patients with VAP caused by NFGNB who received shorter courses of antibiotic therapy. On the contrary, those patients receiving shorter courses trended toward lower rates of recurrence. Pending further prospective trials addressing the duration of antibiotic treatment for patients with VAP caused by NFGNB, shorter courses of treatment, perhaps based on improvement in clinical parameters, may be warranted.
Hedrick
Traci L
TL
University of Virginia Surgical Infectious Disease Laboratory, Charlottesville, Virginia 22908, USA. Th8q@virginia.edu
McElearney
Shannon T
ST
Smith
Robert L
RL
Evans
Heather L
HL
Pruett
Timothy L
TL
Sawyer
Robert G
RG
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents