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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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Kaplan-Meier survival curves for patients randomly assigned to the antibiotic and control groups. The dashed line represents the cumulative survival for patients randomly assigned to the antibiotic group, the solid line represents the cumulative survival for patients randomly assigned to the no antibiotic group, and + represents censored patients. P = 0.047 by the log rank test. ICU, intensive care unit.
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Figure 4: Kaplan-Meier survival curves for patients randomly assigned to the antibiotic and control groups. The dashed line represents the cumulative survival for patients randomly assigned to the antibiotic group, the solid line represents the cumulative survival for patients randomly assigned to the no antibiotic group, and + represents censored patients. P = 0.047 by the log rank test. ICU, intensive care unit.

Mentions: Although the duration of mechanical ventilation and length of ICU stay were similar in the two groups, mechanical ventilation-free days were significantly higher in patients who received antibiotics than in those who did not receive antibiotics. In addition, subsequent VAP and ICU mortality rates were significantly lower in the antibiotic group than in the no antibiotic group. Kaplan-Meier survival curves are presented in Figure 4. Reasons for death included life support withdrawal in 8 patients (4 of 22 [18%] versus 4 of 36 [11%], P = 0.462) and multiple organ failure in 13 patients (0 of 22 versus 13 of 36 [36%], P < 0.001, in the antibiotic and no antibiotic groups, respectively). No significant difference was found in the rates of infection or colonization related to MDR bacteria diagnosed after random assignment (Table 6). No significant difference was found in outcome between different study centers (data not shown). No Clostridium difficile colitis was diagnosed in study patients.


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)

Kaplan-Meier survival curves for patients randomly assigned to the antibiotic and control groups. The dashed line represents the cumulative survival for patients randomly assigned to the antibiotic group, the solid line represents the cumulative survival for patients randomly assigned to the no antibiotic group, and + represents censored patients. P = 0.047 by the log rank test. ICU, intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Kaplan-Meier survival curves for patients randomly assigned to the antibiotic and control groups. The dashed line represents the cumulative survival for patients randomly assigned to the antibiotic group, the solid line represents the cumulative survival for patients randomly assigned to the no antibiotic group, and + represents censored patients. P = 0.047 by the log rank test. ICU, intensive care unit.
Mentions: Although the duration of mechanical ventilation and length of ICU stay were similar in the two groups, mechanical ventilation-free days were significantly higher in patients who received antibiotics than in those who did not receive antibiotics. In addition, subsequent VAP and ICU mortality rates were significantly lower in the antibiotic group than in the no antibiotic group. Kaplan-Meier survival curves are presented in Figure 4. Reasons for death included life support withdrawal in 8 patients (4 of 22 [18%] versus 4 of 36 [11%], P = 0.462) and multiple organ failure in 13 patients (0 of 22 versus 13 of 36 [36%], P < 0.001, in the antibiotic and no antibiotic groups, respectively). No significant difference was found in the rates of infection or colonization related to MDR bacteria diagnosed after random assignment (Table 6). No significant difference was found in outcome between different study centers (data not shown). No Clostridium difficile colitis was diagnosed in study patients.

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