E-viri
Recenzirano
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Bouglé, Adrien; Tuffet, Sophie; Federici, Laura; Leone, Marc; Monsel, Antoine; Dessalle, Thomas; Amour, Julien; Dahyot-Fizelier, Claire; Barbier, François; Luyt, Charles-Edouard; Langeron, Olivier; Cholley, Bernard; Pottecher, Julien; Hissem, Tarik; Lefrant, Jean-Yves; Veber, Benoit; Legrand, Matthieu; Demoule, Alexandre; Kalfon, Pierre; Constantin, Jean-Michel; Rousseau, Alexandra; Simon, Tabassome; Foucrier, Arnaud
Intensive care medicine, 07/2022, Letnik: 48, Številka: 7Journal Article
Purpose Duration of antibiotic therapy for ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA) remains uncertain. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). Methods We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. Results The study was stopped after 24 months due to slow inclusion rate. In intention-to-treat population ( n = 186), the percentage of patients who reached the composite endpoint was 25.5% ( N = 25/98) in the 15-day group versus 35.2% ( N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) −1.9%–21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. Conclusions Our study failed to show the non-inferiority of a short duration of antibiotics in the treatment of PA-VAP, compared to a long duration. The short duration strategy may be associated to an increase of PA-VAP recurrence. However, the lack of power limits the interpretation of this study.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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Vir: Osebne bibliografije
in: SICRIS
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