title: Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury.
abstract: Issues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations.To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients.The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (p<0.001) and VAP onset ≥10 days (p<0.001); the area under the receiver operating characteristic curve (AUC) was 0.822 (95% CI 0.770-0.883) in the learning cohort and 0.805 (95% CI 0.732-0.877) in the validation cohort. The score built from the factors selected in multivariate analysis predicted resistance with a sensitivity of 83%, a specificity of 71%, a positive predictive value of 37% and a negative predictive value of 96% in the validation cohort. The AUC of the multivariate analysis was poor in burn patients (0.671, 95% CI 0.596-0.751).Limited-spectrum empirical antimicrobial therapy has low risk of failure in brain-injured patients presenting with VAP before day 10 and when prior antimicrobial therapy lasts <48 h.
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.affiliation: Plateforme de Biométrie, Cellule de promotion de la recherche clinique, University Hospital of Nantes, Nantes, France EA 4275 SPHERE "Biostatistics, Pharmacoepidemiology & Human Science Research", UFR des Sciences Pharmaceutiques, Nantes University, Nantes, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Rennes, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Angers, Nantes, France.
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Rennes, Rennes, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Launey
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Angers, Nantes, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Thioliere
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Le Floch
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Pierre Joachim
authors.initials: PJ
authors.lastname: Mahe
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Rennes, Rennes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nesseler
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Cazaubiel
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, Laennec, University Hospital of Nantes, Nantes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Rozec
authors.affiliation: Infection Control Unit, Hôtel Dieu - HME, University Hospital of Nantes, Nantes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Lepelletier
authors.affiliation: Plateforme de Biométrie, Cellule de promotion de la recherche clinique, University Hospital of Nantes, Nantes, France EA 4275 SPHERE "Biostatistics, Pharmacoepidemiology & Human Science Research", UFR des Sciences Pharmaceutiques, Nantes University, Nantes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Sebille
authors.affiliation: Intensive Care Unit, Anaesthesia and Critical Care Dept, University Hospital of Rennes, Rennes, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Malledant
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D002056:Burns / Q000150:complications / Q000628:therapy*; D024881:Drug Resistance, Bacterial; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents