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Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.

Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G, Di Pompeo C, Mathieu D, Durocher A, VAT Study Gro - Crit Care (2008)

Bottom Line: Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Réanimation Médicale, boulevard du Pr Leclercq, Hôpital Calmette, CHRU de Lille, 59037 Lille Cedex, France. s-nseir@chru-lille.fr

ABSTRACT

Introduction: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov, number NCT00122057.

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Number of patients randomly assigned to the control group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Two patients had polymicrobial ventilator-associated tracheobronchitis (VAT).
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Figure 3: Number of patients randomly assigned to the control group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Two patients had polymicrobial ventilator-associated tracheobronchitis (VAT).

Mentions: P. aeruginosa was the most frequently isolated bacteria in VAT patients (32%). The rate of fluoroquinolone-resistant P. aeruginosa was similar in the two groups (6 of 8 [75%] versus 8 of 11 [72%], P = 0.689, in the antibiotic and no antibiotic groups, respectively). The microorganisms isolated at a significant threshold are presented in Table 3. In the no antibiotic group, two patients had additional microorganisms cultured at less than 106 cfu/mL (P. aeruginosa and methicillin-sensitive S. aureus). The bacteria identified on quantitative endotracheal aspirate at random assignment were the same as those identified on previous endotracheal aspirate in 48 of 58 (82%) patients (17 of 22 [77%] versus 31 of 36 [86%], P = 0.481, in the antibiotic and no antibiotic groups, respectively). The number of patients with different concentrations of microorganisms at different endpoints is presented in Figures 2 and 3.


Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.

Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G, Di Pompeo C, Mathieu D, Durocher A, VAT Study Gro - Crit Care (2008)

Number of patients randomly assigned to the control group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Two patients had polymicrobial ventilator-associated tracheobronchitis (VAT).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481443&req=5

Figure 3: Number of patients randomly assigned to the control group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Two patients had polymicrobial ventilator-associated tracheobronchitis (VAT).
Mentions: P. aeruginosa was the most frequently isolated bacteria in VAT patients (32%). The rate of fluoroquinolone-resistant P. aeruginosa was similar in the two groups (6 of 8 [75%] versus 8 of 11 [72%], P = 0.689, in the antibiotic and no antibiotic groups, respectively). The microorganisms isolated at a significant threshold are presented in Table 3. In the no antibiotic group, two patients had additional microorganisms cultured at less than 106 cfu/mL (P. aeruginosa and methicillin-sensitive S. aureus). The bacteria identified on quantitative endotracheal aspirate at random assignment were the same as those identified on previous endotracheal aspirate in 48 of 58 (82%) patients (17 of 22 [77%] versus 31 of 36 [86%], P = 0.481, in the antibiotic and no antibiotic groups, respectively). The number of patients with different concentrations of microorganisms at different endpoints is presented in Figures 2 and 3.

Bottom Line: Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Réanimation Médicale, boulevard du Pr Leclercq, Hôpital Calmette, CHRU de Lille, 59037 Lille Cedex, France. s-nseir@chru-lille.fr

ABSTRACT

Introduction: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov, number NCT00122057.

Show MeSH
Related in: MedlinePlus