Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.
BACKGROUND
Ventilator-associated tracheobronchitis (VAT) is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated with reduced duration of mechanical ventilation.


METHODS
We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.


RESULTS
Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median [interquartile range], 12 [8 to 24] versus 2 [0 to 6] days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.


CONCLUSIONS
In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.


BACKGROUND
ClinicalTrials.gov, number NCT00122057.
Nseir
Saad
S
Réanimation Médicale, boulevard du Pr Leclercq, Hôpital Calmette, CHRU de Lille, 59037 Lille Cedex, France. s-nseir@chru-lille.fr
Favory
Raphaël
R
Jozefowicz
Elsa
E
Decamps
Franck
F
Dewavrin
Florent
F
Brunin
Guillaume
G
Di Pompeo
Christophe
C
Mathieu
Daniel
D
Durocher
Alain
A
D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012121:Respiration, Artificial / Q000009:adverse effects*; D013997:Time Factors; D014136:Tracheitis / Q000188:drug therapy*
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015378:Imipenem