| Is an endotracheal routine cultures-based strategy the best way to prescribe antibiotics in ventilator-associated pneumonia? | |
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MedLine Citation:
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PMID: 23348886 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2013-1-24 |
Journal Detail:
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Title: Chest Volume: - ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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