Early-Onset Ventilator-Associated Pneumonia in Adults Randomized Clinical Trial: Comparison of 8 versus 15 Days of Antibiotic Treatment

Abstract

PurposeThe optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria.ObjectiveTo demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia.MethodsRandomized, prospective, open, multicenter trial carried out from 1998 to 2002.MeasurementsThe primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90.Results225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90.ConclusionOur results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients.Trial RegistrationClinicalTrials.gov NCT01559753

Ventilator-associated pneumonia: present understanding and ongoing debates

“…A subsequent study corroborated this finding and confirmed that using 15 versus 8 days of therapy led to no difference in mortality, ICU length of stay, and mechanical ventilation days [59]. However, the rate of secondary infection was higher in the shorter duration group (35.3 vs. 19.3 %, p = 0.01).…”

Ventilator-associated Pneumonia in the ICU

“…Th e role of inhaled antibiotics in the setting of failure of systemic antibiotics is unclear [1]. Th e usual duration of treatment for earlyonset VAP is 8 days and longer in the case of late-onset VAP or if MDR organisms are suspected or identifi ed [39]- [41].…”

Stratégies de réduction de l’utilisation des antibiotiques à visée curative en réanimation (adulte et pédiatrique)

“…Cinq études répon-dant à ces critères ont été conduites en réanimation. Quatre études randomisées contrôlées, ayant comparé deux durées fixes de traitement, concernent les PAVM [224,[244][245][246] chez des patients adultes non immunodéprimés. Une cinquième, en néonatologie, concerne les bactériémies [247].…”