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Comparison of the Bacterial Etiology of Early-Onset Ventilator Associated Pneumonia and Late-Onset Ventilator Associated Pneumonia in Subjects Enrolled in 2 Large Clinical Studies.
MedLine Citation:
PMID:  23307825     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Purpose:To assess potential differences in bacterial etiology of subjects with early-onset vs. late-onset ventilator associated pneumonia (VAP).Methods:Subjects enrolled in 2004-2006 in 2 clinical studies of doripenem vs. 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 days of ventilation) or late-onset VAP (≥5 days of ventilation)]. Baseline demographics and bacterial etiology were analyzed by VAP status.Results:Late-onset VAP subjects had higher APACHE II scores [mean 16.6 vs. 15.5 (p=0.008)]. There were no significant differences in CPIS, gender, age, or presence of bacteremia between 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, pathogens, including potentially MDR, isolated from early vs. late-onset VAP was not significantly different between groups. Acinetobacter baumannii or Pseudomonas aeruginosa with decreased susceptibility to any study drug was observed in early and late onset VAP subjects.Conclusion:There were no significant differences in the prevalence of potential MDR pathogens associated with early or late-onset VAP, even in subjects with prior antibiotics.Clinical Implications:VAP is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. 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:  JOURNAL ARTICLE     Date:  2013-1-9
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
VERDICT (MIR), South Texas Veterans Health Care System Audie L Murphy Division (MIR); the University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary and Critical Care Medicine (MIR, JFF); Janssen Scientific Affairs, (JP, ZQ, ACF, SCN) Janssen Scientific Affairs LLC, 1000 Rt 202s Raritan, NJ 08869.
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