Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.
BACKGROUND
In critically ill intubated patients, signs of respiratory infection often persist despite treatment with potent systemic antibiotics.


OBJECTIVE
The purpose of this study was to determine whether aerosolized antibiotics, which achieve high drug concentrations in the target organ, would more effectively treat respiratory infection and decrease the need for systemic antibiotics.


METHODS
Double-blind, randomized, placebo-controlled study performed from 2003 through 2004.


METHODS
The medical and surgical intensive care units of a university hospital.


METHODS
Critically ill intubated patients were randomized if: 1) > or = 18 yrs of age, intubated for a minimum of 3 days, and expected to survive at least 14 days; and 2) had ventilator-associated tracheobronchitis defined as the production of purulent secretions (> or = 2 mL during 4 hrs) with organism(s) on Gram stain. Of 104 patients monitored, 43 consented for treatment and completed the study. No patients were withdrawn from the study for adverse events.


METHODS
Aerosol antibiotic (AA) or aerosol saline placebo was given for 14 days or until extubation. The responsible clinician determined the administration of systemic antibiotics (SA). Patients were followed for 28 days.


METHODS
Primary: Centers for Disease Control National Nosocomial Infection Survey diagnostic criteria for ventilator-associated pneumonia (VAP) and clinical pulmonary infection score. Secondary: white blood cell count, SA use, acquired antibiotic resistance, and weaning from mechanical ventilation.


RESULTS
Most patients had VAP at randomization. With treatment, the AA group had reduced signs of respiratory infection: reduced Centers for Disease Control National Nosocomial Infection Survey VAP (14/19; 73.6%) to (5/14; 35.7%) vs. placebo (18/24; 75%) to (11/14; 78.6%), reduction in clinical pulmonary infection score, lower white blood cell count at day 14, reduced bacterial resistance, reduced use of SA, and increased weaning (all p < or = .05).


CONCLUSIONS
In critically ill patients with ventilator-associated tracheobronchitis, AA decrease VAP and other signs and symptoms of respiratory infection, facilitate weaning, and reduce bacterial resistance and use of systemic antibiotics.
Palmer
Lucy B
LB
Department of Medicine, Pulmonary/Critical Care Division, University Hospital, State University of New York at Stony Brook, Stony Brook, New York, USA. Lucy.B.Palmer@Stonybrook.edu
Smaldone
Gerald C
GC
Chen
John J
JJ
Baram
Daniel
D
Duan
Tao
T
Monteforte
Melinda
M
Varela
Marie
M
Tempone
Ann K
AK
O'Riordan
Thomas
T
Daroowalla
Feroza
F
Richman
Paul
P
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001991:Bronchitis / Q000145:classification / Q000188:drug therapy* / Q000209:etiology*; D003428:Cross Infection / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D012121:Respiration, Artificial / Q000009:adverse effects*; D014133:Tracheal Diseases / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D015300:Ventilator Weaning
D000900:Anti-Bacterial Agents