Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized controlled multicenter study

Nseir, Saad; Favory, Raphaël; Jozefowicz, Elsa; Decamps, F.; Dewavrin, Florent; Brunin, Guillaume; Pompéo, Christophe Di; Mathieu, Daniel; Durocher, A.

doi:10.1186/cc6890

Cited by 160 publications

(169 citation statements)

References 46 publications

Supporting

Mentioning

153

Contrasting

Unclassified

Order By: Relevance

“…In the present study, systemic antibiotics were frequently administered to VAT patients under the guidance of physicians, in short courses followed by deescalation. Antibiotic treatment in the present study witnessed lower rates of clinical signs and symptoms, faster weaning followed by extubation, Nseir et al, (2008) conducted a randomized, controlled, multicentric study on antimicrobial treatment for ventilator associated tracheobronchitis. And the study suggested that patients with VAT, compared with matched control subjects, had significantly lower median duration of mechanical ventilation and longer duration of ICU stay in patient treated with appropriate antibiotics, but antibiotic therapy did not appear to protect against VAP.…”

Section: Resultsmentioning

confidence: 89%

See 1 more Smart Citation

Ventilator Associated Tracheobronchitis: Incidence, Etiology, Predisposing Risk Factors and Drug Resistance

S¹

2017

Int.J.Curr.Microbiol.App.Sci

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 89%

“…Most of the Acinetobacter baumannii isolates were recovered during 12-13 days of mechanical ventilation. Increasing numbers of lower respiratory tract pathogens over time following intubation are likely to be a sign of increased bacterial virulence, greater inflammation and risk of progression from colonization to VAT (Nseir et al, 2008).…”

Section: Resultsmentioning

confidence: 99%

Ventilator Associated Tracheobronchitis: Incidence, Etiology, Predisposing Risk Factors and Drug Resistance

S¹

2017

Int.J.Curr.Microbiol.App.Sci

View full text Add to dashboard Cite

“…4 Some reports suggest that patients with VAT also have increased length of ICU stay and a prolonged need for mechanical ventilation. 5,6 To gain a better understanding of the molecular mechanisms that underlie the lung phenotypes in VAT vs VAP, we sought to identify and compare their gene expression ''signatures'' using genome-wide oligonucleotide microarrays. We hypothesized that VAP/VAT would exhibit different gene expression signatures which could help to distinguish between the two conditions and would also shed light on their pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

Intubated patients developing tracheobronchitis or pneumonia have distinctive complement system gene expression signatures in the pre-infection period: A pilot study

Martin-Loeches

Papiol

Almansa

et al. 2012

Medicina Intensiva (English Edition)

View full text Add to dashboard Cite

Introduction: It remains unknown why some intubated patients remain infection-free while others develop tracheobronchitis (VAT) or pneumonia (VAP).Objective: To identify and compare VAP/VAT gene expression ''signatures'' using genome-wide oligonucleotide microarrays. Material and methods: A prospective translational study of gene expression profiles of VAP and VAT groups was carried out, establishing comparisons in both pre-infection and infection phases. Pathway and functional analyses were performed with Ingenuity Pathway Analysis (IPA). Data analysis and hierarchical clustering of the genes involved in the signalling pathways expressed differentially in the two groups were performed with GeneSpring GX 11.0. Results: Eight patients developing respiratory infections (3 VAP and 5 VAT) after 4 days of mechanical ventilation were assessed. Comparison of gene expression profiles in the preinfection period revealed 5595 genes expressed differentially between VAP and VAT (p < 0.01, fold change >2). Comparative IPA analysis identified a significant depression of the complement system signalling pathway in the VAP group, affecting the classical pathway along with the final common pathway (p < 0.05). In addition, the cAMP and calcium signalling pathways were also significantly depressed in the VAP group during the pre-infection phase also. Conclusion: Intubated patients complicated with pneumonia developed immune impairment in the pre-infection period, manifesting as a relatively lower expression of genes involved in the complement system that differed from patients developing tracheobronchitis. These findings suggest that a significant proportion of VAP episodes cannot be prevented, but might be treatable through pre-emptive therapy. PALABRAS CLAVE traqueobronquitis (TAV) o neumonía (NAV).Objetivo: Identificar y comparar los patrones de la expresión genética de la NAV/TAV usando micromatrices multigénicas oligonucleotídicas. Material y métodos: Se realizó un estudio aplicado prospectivo de los patrones de la expresión genética de los grupos con NAV y TAV, estableciendo comparaciones tanto en la fase previa a la infección como en la fase infecciosa. Se realizaron análisis de vías y funcionales con Ingenuity Pathway (IPA). Los análisis de datos y el agrupamiento jerárquico de los genes implicados en las vías de señalización expresados de forma diferenciada en ambos grupos se realizaron con GeneSpring GX 11.0. Resultados: Se evaluaron ocho pacientes que presentaron infecciones respiratorias (3 NAV y 5 TAV) después de 4 días con la ventilación mecánica. La comparación de los perfiles de la expresión genética durante el período previo a la infección reveló 5.595 genes expresados de forma diferenciada entre la NAV y la TAV (p < 0,01, cambio múltiplo > 2). Los análisis comparativos de los IPA identificaron una depresión importante de la vía de señalización del sistema del complemento en el grupo con NAV, que afectó a la vía clásica además de a la vía común final (p < 0,05). Por otra parte, el monofosfato cíclico de...

show abstract

“…The majority of studies (3/4 studies) showed that antimicrobial treatment did not decrease the duration of mechanical ventilation or length of stay in an ICU, although two randomized controlled trials showed that the frequency of progression to VAP was lower in patients receiving antimicrobial therapy for VAT (251). Nseir and colleagues completed several well-designed trials with patients with VAT indicating that systemic antibiotic therapy improves outcomes and re-duces the progression to VAP, although these studies did not examine inhaled therapies (252). Despite the limited number of reported studies evaluating the use of inhaled antibiotics for VAT, given the localized pathophysiology, it is sensible to conclude that inhaled agents may be equally as effective as systemic agents with regard to clinical and microbiological outcomes.…”

Section: Ventilator-associated Tracheobronchitismentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

View full text Add to dashboard Cite

SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

show abstract

Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized controlled multicenter study

Abstract: Introduction Ventilator-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.

Cited by 160 publications

References 46 publications

Ventilator Associated Tracheobronchitis: Incidence, Etiology, Predisposing Risk Factors and Drug Resistance

Ventilator Associated Tracheobronchitis: Incidence, Etiology, Predisposing Risk Factors and Drug Resistance

Intubated patients developing tracheobronchitis or pneumonia have distinctive complement system gene expression signatures in the pre-infection period: A pilot study

Inhaled Antibiotics for Gram-Negative Respiratory Infections

Contact Info

Product

Resources

About