Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. 2007

Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
Department of Pharmacy Services, The University Hospital, Cincinnati, Ohio, USA. MuelleEW@healthall.com

BACKGROUND Using an arbitrary day cutoff or clinical signs to decide the duration of antibiotic therapy for ventilator-associated pneumonia (VAP) may be suboptimal for some patients. We sought to determine whether antibiotic duration for VAP can be safely abbreviated in trauma patients using repeat bronchoalveolar lavage (BAL). METHODS This was an observational case-controlled pilot study. Fifty-two patients were treated for VAP using a repeat BAL clinical pathway. Definitive antibiotic therapy for VAP was discontinued if pathogen growth was <10,000 colony forming units/mL on repeat BAL performed on day 4 of antibiotic therapy (responder), otherwise therapy was continued per managing team. A matched control group of 52 VAP patients treated before (immediately consecutive) the pathway was used for comparison. RESULTS Antibiotic duration in pathway patients was shorter than control patients (9.8 days +/- 3.8 days vs. 16.7 days +/- 7.4 days; p < 0.001), including nonfermenting gram-negative bacilli VAP (10.7 days +/- 4.1 days vs. 14.4 days +/- 4.2 days; p < 0.001). There were no differences in pneumonia relapse, mechanical ventilator-free intensive care unit (ICU) days, ICU-free hospital days, or mortality. Of study group isolates, 86 (82.7%) responded on repeat BAL and were treated for 8.8 days +/- 3.3 days. Of these without concomitant infections (n = 65), antibiotic duration was 7.3 days +/- 1.2 days compared with 14.4 days +/- 2.6 days for nonresponding isolates (n = 18) (p < 0.001). CONCLUSIONS Repeat BAL decreased the duration of antibiotic therapy for VAP in trauma patients. More adequately powered investigations are needed to appropriately determine the effects of this strategy on patient outcome.

UI MeSH Term Description Entries
D007362 Intensive Care Units Hospital units providing continuous surveillance and care to acutely ill patients. ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D008297 Male Males
D004334 Drug Administration Schedule Time schedule for administration of a drug in order to achieve optimum effectiveness and convenience. Administration Schedule, Drug,Administration Schedules, Drug,Drug Administration Schedules,Schedule, Drug Administration,Schedules, Drug Administration
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000900 Anti-Bacterial Agents Substances that inhibit the growth or reproduction of BACTERIA. Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial
D016022 Case-Control Studies Comparisons that start with the identification of persons with the disease or outcome of interest and a control (comparison, referent) group without the disease or outcome of interest. The relationship of an attribute is examined by comparing both groups with regard to the frequency or levels of outcome over time. Case-Base Studies,Case-Comparison Studies,Case-Referent Studies,Matched Case-Control Studies,Nested Case-Control Studies,Case Control Studies,Case-Compeer Studies,Case-Referrent Studies,Case Base Studies,Case Comparison Studies,Case Control Study,Case Referent Studies,Case Referrent Studies,Case-Comparison Study,Case-Control Studies, Matched,Case-Control Studies, Nested,Case-Control Study,Case-Control Study, Matched,Case-Control Study, Nested,Case-Referent Study,Case-Referrent Study,Matched Case Control Studies,Matched Case-Control Study,Nested Case Control Studies,Nested Case-Control Study,Studies, Case Control,Studies, Case-Base,Studies, Case-Comparison,Studies, Case-Compeer,Studies, Case-Control,Studies, Case-Referent,Studies, Case-Referrent,Studies, Matched Case-Control,Studies, Nested Case-Control,Study, Case Control,Study, Case-Comparison,Study, Case-Control,Study, Case-Referent,Study, Case-Referrent,Study, Matched Case-Control,Study, Nested Case-Control
D017052 Hospital Mortality A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. In-Hospital Mortality,Mortality, Hospital,Hospital Mortalities,In Hospital Mortalities,In Hospital Mortality,Inhospital Mortalities,Inhospital Mortality,Mortalities, In-house,Mortalities, Inhospital,Mortality, In-Hospital,Mortality, Inhospital,Hospital Mortalities, In,Hospital Mortality, In,In-Hospital Mortalities,In-house Mortalities,In-house Mortality,Mortalities, Hospital,Mortalities, In Hospital,Mortalities, In house,Mortalities, In-Hospital,Mortality, In Hospital,Mortality, In-house

Related Publications

Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
March 2022, Health science reports,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
January 2006, The Turkish journal of pediatrics,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
February 2013, The journal of trauma and acute care surgery,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
October 2007, Anaesthesia,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
August 2003, The Journal of trauma,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
September 2009, Journal of clinical microbiology,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
July 1996, The European respiratory journal,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
December 2012, Surgical infections,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
April 2003, Intensive care medicine,
Eric W Mueller, and Martin A Croce, and Bradley A Boucher, and Scott D Hanes, and G Christopher Wood, and Joseph M Swanson, and Shanna K Chennault, and Timothy C Fabian
May 2024, The Lancet. Respiratory medicine,
Copied contents to your clipboard!