title: Ultra-Short-Course Antibiotics for Patients With Suspected Ventilator-Associated Pneumonia but Minimal and Stable Ventilator Settings.
abstract: BACKGROUND
  Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation. We compared outcomes among patients with suspected VAP but minimal and stable ventilator settings treated with 1-3 days vs >3 days of antibiotics.
  
  
  METHODS
  We identified consecutive adult patients started on antibiotics for possible VAP with daily minimum positive end-expiratory pressure of ≤5 cm H2O and fraction of inspired oxygen ≤40% for at least 3 days within a large tertiary care hospital between 2006 and 2014. We compared time to extubation alive vs ventilator death and time to hospital discharge alive vs hospital death using competing risks models among patients prescribed 1-3 days vs >3 days of antibiotics. All models were adjusted for patient demographics, comorbidities, severity of illness, clinical signs of infection, and pathogens.
  
  
  RESULTS
  There were 1290 eligible patients, 259 treated for 1-3 days and 1031 treated for >3 days. The 2 groups had similar demographics, comorbidities, and clinical signs. There were no significant differences between groups in time to extubation alive (hazard ratio [HR], 1.16 for short- vs long-course treatment; 95% confidence interval [CI], .98-1.36), ventilator death (HR, 0.82 [95% CI, .55-1.22]), time to hospital discharge alive (HR, 1.07 [95% CI, .91-1.26]), or hospital death (HR, 0.99 [95% CI, .75-1.31]).
  
  
  CONCLUSIONS
  Very short antibiotic courses (1-3 days) were associated with outcomes similar to longer courses (>3 days) in patients with suspected VAP but minimal and stable ventilator settings. Assessing serial ventilator settings may help clinicians identify candidates for early antibiotic discontinuation.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and.|Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and.
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and.
authors.forename: John T
authors.initials: JT
authors.lastname: Menchaca
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Gruber
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers
keywords: antibiotic de-escalation; antibiotic stewardship; mechanical ventilation; quality improvement; ventilator-associated pneumonia