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Is an endotracheal routine cultures-based strategy the best way to prescribe antibiotics in ventilator-associated pneumonia?
MedLine Citation:
PMID:  23348886     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT OBJECTIVES: to evaluate if a strategy based on routine endotracheal aspirate (ETA) cultures is better than using the ATS/IDSA guidelines to prescribe antimicrobials in ventilator associated pneumonia (VAP). DESIGN: prospective observational cohort study SETTING: a 15-bed intensive care unit. PATIENTS: 283 patients mechanically ventilated for ≥48h. INTERVENTIONS: twice weekly ETA; bronchoalveolar lavage (BAL) culture if VAP was suspected. MEASUREMENTS: 146 different pairs of BAL (collected at the time of VAP)+ETA cultures (collected ≤ 7 days before VAP), were defined. We compared 2 models of 10 days of empiric antimicrobials (ETA-based vs ATS/IDSA guidelines-based strategies), analyzing their impact on appropriateness of therapy and total antimicrobial-days, using the BAL result as the standard for comparison. RESULTS: complete ETA and BAL concordance (identical pathogens or negative result) happened in 52 pairs; discordance (false positive or false negative) in 67, and partial concordance in 2. ETA predicted the etiology in 62.4% of all pairs; in 74.0% of pairs if ETA was performed ≤2 days before BAL and in 46.2% if it was performed 3-7 days before BAL (p=0.016).Strategies based on the ATS/IDSA guidelines and on ETA results, led to appropriate therapy in 97.9% and 77.4% of pairs, respectively (p<0.001). The number of antimicrobial-days were 1942 and 1557, respectively (p<0.001). CONCLUSION: the ATS/IDSA guidelines-based approach was more accurate than the ETA-based strategy, for prescribing appropriate initial empiric antibiotics in VAP, unless a sample is available ≤2 days of the onset of VAP. The ETA-based strategy led to fewer prescribed antimicrobial days.
Authors:
C M Luna; S Sarquis; M Niederman; A Sosa; M Otaola; N Bailleau; C A Vay; A Famiglietti; C Irrazabal; A Capdevila
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-24
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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