Durée de l’antibiothérapie lors du traitement des pneumopathies acquises sous ventilation mécanique : comparaison entre sept jours et dix jours. Étude pilote

Hassen, M. Fekih; Ayed, S.; Gharbi, R.; Marghli, Soudani; Elatrous, Souheil

doi:10.1016/j.annfar.2008.10.021

Cited by 34 publications

(5 citation statements)

References 31 publications

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“…One small VAP trial randomly assigned 30 patients to 7 or 10 days of culture-directed antibiotic therapy, and similar rates of survival among those treated for 7 days (64.3%) and 10 days (62.5%) were reported [41]. The numbers of patients with bacteremia or their outcomes were not provided [41].…”

Section: Resultsmentioning

confidence: 99%

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Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

2011

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IntroductionThe optimal duration of antibiotic therapy for bloodstream infections is unknown. Shorter durations of therapy have been demonstrated to be as effective as longer durations for many common infections; similar findings in bacteremia could enable hospitals to reduce antibiotic utilization, adverse events, resistance and costs.MethodsA search of the MEDLINE, EMBASE and COCHRANE databases was conducted for the years 1947-2010. Controlled trials were identified that randomized patients to shorter versus longer durations of treatment for bacteremia, or the infectious foci most commonly causing bacteremia in critically ill patients (catheter-related bloodstream infections (CRBSI), intra-abdominal infections, pneumonia, pyelonephritis and skin and soft-tissue infections (SSTI)).ResultsTwenty-four eligible trials were identified, including one trial focusing exclusively on bacteremia, zero in catheter related bloodstream infection, three in intra-abdominal infection, six in pyelonephritis, thirteen in pneumonia and one in skin and soft tissue infection. Thirteen studies reported on 227 patients with bacteremia allocated to 'shorter' or 'longer' durations of treatment. Outcome data were available for 155 bacteremic patients: neonatal bacteremia (n = 66); intra-abdominal infection (40); pyelonephritis (9); and pneumonia (40). Among bacteremic patients receiving shorter (5-7 days) versus longer (7-21 days) antibiotic therapy, no significant difference was detected with respect to rates of clinical cure (45/52 versus 47/49, risk ratio 0.88, 95% confidence interval [CI] 0.77-1.01), microbiologic cure (28/28 versus 30/32, risk ratio 1.05, 95% CI 0.91-1.21), and survival (15/17 versus 26/29, risk ratio 0.97, 95% CI 0.76-1.23).ConclusionsNo significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings.

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Section: Resultsmentioning

confidence: 99%

“…The numbers of patients with bacteremia or their outcomes were not provided [41]. In a large, multicenter, high-quality trial that randomly assigned 402 adult patients to 8 or 15 days of therapy [42], survival was not different: 160 out of 197 (81.2%) versus 169 out of 204 (82.8%) [42].…”

Section: Resultsmentioning

confidence: 99%

Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

2011

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“…We identified two recent systematic reviews which included six RCTs comparing short (7-8 days) with long (10-15 days) durations of antibiotic therapy in mixed early-and late-onset VAP populations [85,86]. Two French studies compared 8-15-day antibiotic regimens, two others compared 7-10-day antibiotic regimens and one study compared 8-12-day antibiotic regimens [87][88][89][90][91]. One study [92] discontinued the antibiotic at day 3 if the CPIS score was <7, while others continued the treatment at the discretion of the treating physician.…”

Section: Benefits and Harmsmentioning

confidence: 99%

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

et al. 2017

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The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

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“…Recently, duration of adequate antibiotic therapy was found to be not associated with treatment failure in a retrospective cohort of patients with PA-VAP [7]. Moreover, three trials [15–17] and a Cochrane meta-analysis [18] failed to demonstrate that a short fixed-course (7 or 8 days) antibiotic therapy could be associated with an increase in mortality or recurrence rate for patients with a pneumonia documented with PA or other NF-GNB. Finally, a recent meta-analysis concluded that the two strategies did not differ in terms of 28 day mortality, but because of lack of power, these conclusions remain a matter of debate [19].…”

Section: Introductionmentioning

confidence: 99%

Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study

Bouglé

Foucrier

Dupont

et al. 2017

Trials

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BackgroundVentilator-associated pneumonia (VAP) accounts for 25% of infections in intensive care units. Compared to a long duration (LD) of antibiotic therapy, a short duration (SD) has a comparable clinical efficacy with less antibiotic use and less multidrug-resistant (MDR) pathogen emergence, with the exception of documented VAP of non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA). These results have led the American Thoracic Society to recommend SD therapy for VAP, except for PA-VAP. Thus the beneficial effect of SD therapy in PA-VAP is still a matter of debate. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) versus prolonged antibiotic therapy (15 days) in PA-VAP.Methods/designThe impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia (iDIAPASON) trial is a randomized, open-labeled non-inferiority controlled trial, conducted in 34 French intensive care units (ICUs), comparing two groups of patients with PA-VAP according to the duration (8 days or 15 days) of effective antibiotic therapy against PA. The primary outcome is a composite endpoint combining day 90 mortality and PA-VAP recurrence rate during hospitalization in the ICU. Furthermore, durations of mechanical ventilation and hospitalization, as well as number and types of extrapulmonary infections or acquisition of MDR pathogens during the hospitalization in the ICU will be recorded. Recurrence with predefined criteria (clinical suspicion of VAP associated with a positive quantitative culture of a respiratory sample) will be evaluated by two independent experts.DiscussionDemonstrating that an SD (8 days) versus LD (15 days) therapy strategy in PA-VAP treatment is safe and not associated with an increased mortality or recurrence rate could lead to a change in practices and guidelines in the management of antibiotic therapy of this frequent ICU complication. This strategy could lead to decreased antibiotic exposure during hospitalization in the ICU and in turn reduce the acquisition and the spread of MDR pathogens.Trial registrationClinicalTrials.gov: NCT02634411. Registered on 19 November 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1780-3) contains supplementary material, which is available to authorized users.

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Durée de l’antibiothérapie lors du traitement des pneumopathies acquises sous ventilation mécanique : comparaison entre sept jours et dix jours. Étude pilote

Cited by 34 publications

References 31 publications

Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study

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