Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter studyReport as inadecuate




Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 12:R62

First Online: 02 May 2008Received: 18 February 2008Revised: 07 April 2008Accepted: 02 May 2008

Abstract

IntroductionVentilator-associated tracheobronchitis VAT is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated with reduced duration of mechanical ventilation.

MethodsWe conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned 1:1 to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia VAP prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit ICU mortality.

ResultsFifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic n = 22 and no antibiotic n = 36 groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher median interquartile range, 12 8 to 24 versus 2 0 to 6 days, P < 0.001 in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP 13% versus 47%, P = 0.011, odds ratio OR 0.17, 95% confidence interval CI 0.04 to 0.70 and ICU mortality 18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88 rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.

ConclusionIn patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.

Trial registrationClinicalTrials.gov, number NCT00122057.

AbbreviationsATSAmerican Thoracic Society

cfucolony-forming units

COPDchronic obstructive pulmonary disease

HRCThigh-resolution computed tomography

ICUintensive care unit

ITTintention-to-treat

MDRmultidrug-resistant

VAPventilator-associated pneumonia

VATventilator-associated tracheobronchitis.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6890 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Author: Saad Nseir - Raphaël Favory - Elsa Jozefowicz - Franck Decamps - Florent Dewavrin - Guillaume Brunin - Christophe Di Pompe

Source: https://link.springer.com/



DOWNLOAD PDF




Related documents