Document Detail


Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia.
MedLine Citation:
PMID:  18712348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP. DESIGN AND SETTING: Retrospective analysis of prospectively collected data in a medical-surgical intensive care unit (ICU) of a university hospital. PATIENTS AND METHODS: We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA-BAL (concordant group), discordant EA-BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups. MEASUREMENTS AND MAIN RESULTS: Ninety assessable EA-BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P < 0.05) to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate. No significant difference was observed between the three groups for length of mechanical ventilation, length of ICU stay, nonpulmonary nosocomial infections and mortality. CONCLUSION: Once-a-week routine quantitative EA cultures may help to improve the adequacy of empiric antibiotic therapy for VAP.
Authors:
Boris Jung; Mustapha Sebbane; Gerald Chanques; Patricia Courouble; Daniel Verzilli; Pierre-François Perrigault; Helene Jean-Pierre; Jean-Jacques Eledjam; Samir Jaber
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Publication Detail:
Type:  Journal Article     Date:  2008-08-19
Journal Detail:
Title:  Intensive care medicine     Volume:  35     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-19     Completed Date:  2009-06-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  101-7     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Department of Critical Care and Anesthesiology, DAR B CHU de Montpellier, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / therapeutic use*
Bronchoalveolar Lavage Fluid / microbiology*
Cohort Studies
Female
Gram-Negative Bacteria / isolation & purification
Gram-Positive Cocci / isolation & purification
Hospitals, University
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia, Ventilator-Associated / drug therapy*,  microbiology*
Predictive Value of Tests
Retrospective Studies
Trachea / microbiology*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Comment In:
Intensive Care Med. 2008 Dec;34(12):2130-3   [PMID:  18712347 ]

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


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