The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study.
OBJECTIVE
The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP).


METHODS
This was a secondary analysis from a multicenter trial of 740 patients with suspected VAP randomized to bronchoscopy or endotracheal aspirate cultures; all received empirical broad-spectrum antibiotics. Patients were grouped by whether they received TT, defined as tailoring or discontinuing antibiotics in response to enrolment culture results.


RESULTS
For patients with a positive culture (n = 412), baseline demographics, clinical progression of infection and multiple organ dysfunction scores (MODS), and mortality were similar for those on TT (n = 320) or those who did not receive TT (NoTT) (n = 92). The TT group had more days alive and off broad-spectrum antibiotics (14.5 vs 13.2, P = .04). In patients with a negative culture (n = 327), those on TT (n = 230) had similar baseline demographics, less frequent final adjudicated diagnosis of VAP (63.0% vs 76.3%, P = .02), and less severe clinical progression of infection and MODS compared with NoTT (n = 97). The TT group had more days alive and off broad-spectrum antibiotics (15.9 vs 13.1, P < .001), lower delta MODS (2.0 vs 3.0, P = .01), fewer mechanical ventilation days (9.8 vs 14.7, P = .03), and similar mortality compared to NoTT.


CONCLUSIONS
Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
Joffe
Ari R
AR
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada T6G 2B7.
Muscedere
John
J
Marshall
John C
JC
Su
Yinghua
Y
Heyland
Daren K
DK
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D002170:Canada; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D013183:Sputum / Q000382:microbiology; D018709:Statistics, Nonparametric; D013396:Suction; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents