Document Detail


Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies.
MedLine Citation:
PMID:  23307825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ventilator-associated pneumonia (VAP) is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. We assessed differences in the bacterial etiology of early-onset versus late-onset VAP.
METHODS: Subjects enrolled in 2004-2006 in 2 clinical studies of doripenem versus imipenem or piperacillin/tazobactam, with a diagnosis of VAP (n = 500) were included in the analysis. Subjects were classified by ventilator status: early-onset VAP (< 5 d of ventilation) or late-onset VAP (≥ 5 d of ventilation). Baseline demographics and bacterial etiology were analyzed by VAP status.
RESULTS: Late-onset VAP subjects had higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (mean 16.6 versus 15.5, P = .008). There were no significant differences in Clinical Pulmonary Infection Score, sex, age, or presence of bacteremia between the groups. A total of 496 subjects had a baseline pathogen, and 50% of subjects in each group had ≥ 2 pathogens. With the exception of Staphylococcus aureus, which was common in early-onset VAP, the pathogens (including potentially multidrug-resistant (MDR) pathogens) isolated from early-onset versus late-onset VAP were not significantly different between groups. Acinetobacter baumannii or Pseudomonas aeruginosa with decreased susceptibility to any study drug was observed in early-onset and late-onset VAP subjects.
CONCLUSIONS: There were no significant differences in the prevalence of potential MDR pathogens associated with early-onset or late-onset VAP, even in subjects with prior antibiotics. Empiric therapy for early-onset VAP should also include agents likely to be effective for potential MDR pathogens. Further prospective studies should evaluate microbiology trends in subjects with VAP.
Authors:
Marcos I Restrepo; Janet Peterson; Juan F Fernandez; Zhihai Qin; Alan C Fisher; Susan C Nicholson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-09
Journal Detail:
Title:  Respiratory care     Volume:  58     ISSN:  1943-3654     ISO Abbreviation:  Respir Care     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-26     Completed Date:  2014-04-08     Revised Date:  2014-06-25    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1220-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
APACHE
Acinetobacter baumannii* / drug effects,  isolation & purification
Adult
Age Factors
Aged
Anti-Bacterial Agents / classification,  therapeutic use
Bacteremia* / drug therapy,  epidemiology,  microbiology
Drug Resistance, Microbial
Female
Humans
Intensive Care Units / statistics & numerical data
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Pneumonia, Ventilator-Associated* / drug therapy,  epidemiology,  microbiology
Prevalence
Pseudomonas aeruginosa* / drug effects,  isolation & purification
Respiration, Artificial / adverse effects*
Retrospective Studies
Sex Factors
Staphylococcus aureus* / drug effects,  isolation & purification
Statistics as Topic
Time Factors
Grant Support
ID/Acronym/Agency:
K23 HL096054/HL/NHLBI NIH HHS; K23HL096054/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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