Ventilator-associated pneumonia (VAP) is one of the leading causes of morbidity and mortality in hospitalized patients. It typically occurs in approximately 30% of all mechanically ventilated patients and is associated with an average increase of 7-9 days of hospitalization with over $ 40,000 additional cost per patient.1-5
A recently published study6 compared antibiotic utilization and mortality in empirically treated, culture-negative VAP patients whose antibiotic discontinuation was early versus late. This was a retrospective, observational cohort study that included 89 patients with clinically suspected VAP and a negative (<104 colony forming units (CFU)/mL) quantitative bronchoscopy culture between January 2009 and March 2012. The authors defined early discontinuation as those patients who had all antibiotic therapy stopped within one day of final negative culture report (n = 40), whereas late discontinuation was defined as those patients who had their antibiotics stopped later than one day (n = 49).
The authors found no difference in mortality between early and late discontinuation (25 vs. 30.6%, p = 0.642) patients. There were fewer super-infections (22.5 vs. 42.9%, p = 0.008), respiratory super-infections (10.0 vs. 28.6%, p = 0.036), and MDR super-infections (7.5 vs. 35.7%, p = 0.003), in early discontinuation and late discontinuation patients, respectively.
In conclusion, it appears that in patients who are severely ill and have clinically suspected VAP but negative bronchoscopy cultures, early discontinuation of antibiotics did not affect mortality but was associated with a lower frequency of MDR super-infections.
1. American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med.
2. Cardo D, Horan T, Andrus M, et al. National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control.
3. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA
4. Rello J, Ollendorf DA, Oster G, et al. VAP outcomes scientific advisory group: Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest.
5. Chastre J, Fagon JY. Ventilator associated pneumonia. Am J Respir Crit Care Med