Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures
OBJECTIVES:Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negati...
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| Veröffentlicht in: | Critical care medicine 2013-07, Vol.41 (7), p.1656-1663 |
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| creator | Raman, Kirthana Nailor, Michael D Nicolau, David P Aslanzadeh, Jaber Nadeau, Michelle Kuti, Joseph L |
| description | OBJECTIVES:Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negative quantitative bronchoscopy cultures, we compared antibiotic utilization and mortality in empirically treated, culture-negative ventilator-associated pneumonia patients whose antibiotic discontinuation was early versus late.
DESIGN:Retrospective, observational cohort study.
SETTING:Eight hundred sixty-seven bed, tertiary care, teaching hospital in Hartford, CT.
PATIENTS:Eighty-nine patients with clinically suspected ventilator-associated pneumonia and a negative ( |
| doi_str_mv | 10.1097/CCM.0b013e318287f713 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1369718512</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1369718512</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3863-86bb293bd04f15becc5512d75d9fea491e74f20272bbe287f560202b8f53fedc3</originalsourceid><addsrcrecordid>eNp9kU2PFCEQhonRuOPqPzCGi4mXXqFpBvo4tutqsuoav44doKsdlIFZPtzMH9nfK5MZNfHgCap46i2qXoQeU3JGSS-eD8PbM6IJZcCobKWYBWV30IJyRhrS9uwuWhDSk4Z1PTtBD1L6TgjtuGD30UnLeCsl4Qt0e66i2-GVz1bbkK3BL20yoYa-qGyDx9bjq3oDnxP-avMaD856a5SrZR9L2oLJMOEv9d06lUNsVikFY9U-e-WhbIK3Cis_4XfwrQr9BPyhqErnQ_AiBm_WoTbd7vBQXC4R0kN0b1YuwaPjeYo-vzr_NLxuLt9fvBlWl41hcskaudS6jqon0s2UazCGc9pOgk_9DKrrKYhubkkrWq1hvyO-JDXUcuZshsmwU_TsoLuN4bpAyuOmjg_OKQ-hpJGyZS-orKIV7Q6oiSGlCPO4jXaj4m6kZNw7MlZHxn8dqWVPjh2K3sD0p-i3BRV4egRUqludo_LGpr-c6CRp2V5IHrib4DLE9MOVG4jjGpTL6___4RcDHqpb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1369718512</pqid></control><display><type>article</type><title>Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Raman, Kirthana ; Nailor, Michael D ; Nicolau, David P ; Aslanzadeh, Jaber ; Nadeau, Michelle ; Kuti, Joseph L</creator><creatorcontrib>Raman, Kirthana ; Nailor, Michael D ; Nicolau, David P ; Aslanzadeh, Jaber ; Nadeau, Michelle ; Kuti, Joseph L</creatorcontrib><description>OBJECTIVES:Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negative quantitative bronchoscopy cultures, we compared antibiotic utilization and mortality in empirically treated, culture-negative ventilator-associated pneumonia patients whose antibiotic discontinuation was early versus late.
DESIGN:Retrospective, observational cohort study.
SETTING:Eight hundred sixty-seven bed, tertiary care, teaching hospital in Hartford, CT.
PATIENTS:Eighty-nine patients with clinically suspected ventilator-associated pneumonia and a negative (<10 colony forming units/mL) quantitative bronchoscopy culture between January 2009 and March 2012. Early discontinuation patients (n = 40) were defined as those who had all antibiotic therapy stopped within one day of final negative culture report, whereas late discontinuation patients (n = 49) had antibiotics stopped later than one day.
MEASUREMENTS:Univariate analyses assessed mortality, antibiotic duration, and frequency of superinfections. Multivariate logistic regression was performed to assess the effect of early discontinuation on hospital mortality.
RESULTS:Patients had a mean ± SD Acute Physiology and Chronic Health Evaluation II score of 26.0 ± 6.0. Mortality was not different between early discontinuation (25.0%) and late discontinuation (30.6%) patients (p = 0.642). Antibiotic duration (days) was also not different for patients who died vs. those who survived (Median [interquartile range]3 [1–7.5] vs. 3 [1.75–6.25], respectively, p = 0.87), and when controlling for baseline characteristics and symptom resolution, only Acute Physiology and Chronic Health Evaluation II score was associated with hospital mortality on multivariate analyses. There were fewer superinfections (22.5% vs. 42.9%, p = 0.008), respiratory superinfections (10.0% vs. 28.6%, p = 0.036), and multidrug resistant superinfections (7.5% vs. 35.7%, p = 0.003), in early discontinuation compared with late discontinuation patients.
CONCLUSIONS:In this severely ill population with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoalveolar lavage cultures, early discontinuation of antibiotics did not affect mortality and was associated with a lower frequency of MDR superinfections.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e318287f713</identifier><identifier>PMID: 23528805</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; APACHE ; Biological and medical sciences ; Bronchoalveolar Lavage Fluid - microbiology ; Drug Administration Schedule ; Female ; General aspects ; Hospital Mortality ; Hospitals, Teaching ; Human infectious diseases. Experimental studies and models ; Humans ; Infectious diseases ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Pneumonia, Ventilator-Associated - complications ; Pneumonia, Ventilator-Associated - diagnosis ; Pneumonia, Ventilator-Associated - drug therapy ; Retrospective Studies ; Superinfection - etiology</subject><ispartof>Critical care medicine, 2013-07, Vol.41 (7), p.1656-1663</ispartof><rights>2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3863-86bb293bd04f15becc5512d75d9fea491e74f20272bbe287f560202b8f53fedc3</citedby><cites>FETCH-LOGICAL-c3863-86bb293bd04f15becc5512d75d9fea491e74f20272bbe287f560202b8f53fedc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27480233$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23528805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raman, Kirthana</creatorcontrib><creatorcontrib>Nailor, Michael D</creatorcontrib><creatorcontrib>Nicolau, David P</creatorcontrib><creatorcontrib>Aslanzadeh, Jaber</creatorcontrib><creatorcontrib>Nadeau, Michelle</creatorcontrib><creatorcontrib>Kuti, Joseph L</creatorcontrib><title>Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVES:Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negative quantitative bronchoscopy cultures, we compared antibiotic utilization and mortality in empirically treated, culture-negative ventilator-associated pneumonia patients whose antibiotic discontinuation was early versus late.
DESIGN:Retrospective, observational cohort study.
SETTING:Eight hundred sixty-seven bed, tertiary care, teaching hospital in Hartford, CT.
PATIENTS:Eighty-nine patients with clinically suspected ventilator-associated pneumonia and a negative (<10 colony forming units/mL) quantitative bronchoscopy culture between January 2009 and March 2012. Early discontinuation patients (n = 40) were defined as those who had all antibiotic therapy stopped within one day of final negative culture report, whereas late discontinuation patients (n = 49) had antibiotics stopped later than one day.
MEASUREMENTS:Univariate analyses assessed mortality, antibiotic duration, and frequency of superinfections. Multivariate logistic regression was performed to assess the effect of early discontinuation on hospital mortality.
RESULTS:Patients had a mean ± SD Acute Physiology and Chronic Health Evaluation II score of 26.0 ± 6.0. Mortality was not different between early discontinuation (25.0%) and late discontinuation (30.6%) patients (p = 0.642). Antibiotic duration (days) was also not different for patients who died vs. those who survived (Median [interquartile range]3 [1–7.5] vs. 3 [1.75–6.25], respectively, p = 0.87), and when controlling for baseline characteristics and symptom resolution, only Acute Physiology and Chronic Health Evaluation II score was associated with hospital mortality on multivariate analyses. There were fewer superinfections (22.5% vs. 42.9%, p = 0.008), respiratory superinfections (10.0% vs. 28.6%, p = 0.036), and multidrug resistant superinfections (7.5% vs. 35.7%, p = 0.003), in early discontinuation compared with late discontinuation patients.
CONCLUSIONS:In this severely ill population with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoalveolar lavage cultures, early discontinuation of antibiotics did not affect mortality and was associated with a lower frequency of MDR superinfections.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Bronchoalveolar Lavage Fluid - microbiology</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>General aspects</subject><subject>Hospital Mortality</subject><subject>Hospitals, Teaching</subject><subject>Human infectious diseases. Experimental studies and models</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumonia, Ventilator-Associated - complications</subject><subject>Pneumonia, Ventilator-Associated - diagnosis</subject><subject>Pneumonia, Ventilator-Associated - drug therapy</subject><subject>Retrospective Studies</subject><subject>Superinfection - etiology</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2PFCEQhonRuOPqPzCGi4mXXqFpBvo4tutqsuoav44doKsdlIFZPtzMH9nfK5MZNfHgCap46i2qXoQeU3JGSS-eD8PbM6IJZcCobKWYBWV30IJyRhrS9uwuWhDSk4Z1PTtBD1L6TgjtuGD30UnLeCsl4Qt0e66i2-GVz1bbkK3BL20yoYa-qGyDx9bjq3oDnxP-avMaD856a5SrZR9L2oLJMOEv9d06lUNsVikFY9U-e-WhbIK3Cis_4XfwrQr9BPyhqErnQ_AiBm_WoTbd7vBQXC4R0kN0b1YuwaPjeYo-vzr_NLxuLt9fvBlWl41hcskaudS6jqon0s2UazCGc9pOgk_9DKrrKYhubkkrWq1hvyO-JDXUcuZshsmwU_TsoLuN4bpAyuOmjg_OKQ-hpJGyZS-orKIV7Q6oiSGlCPO4jXaj4m6kZNw7MlZHxn8dqWVPjh2K3sD0p-i3BRV4egRUqludo_LGpr-c6CRp2V5IHrib4DLE9MOVG4jjGpTL6___4RcDHqpb</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Raman, Kirthana</creator><creator>Nailor, Michael D</creator><creator>Nicolau, David P</creator><creator>Aslanzadeh, Jaber</creator><creator>Nadeau, Michelle</creator><creator>Kuti, Joseph L</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures</title><author>Raman, Kirthana ; Nailor, Michael D ; Nicolau, David P ; Aslanzadeh, Jaber ; Nadeau, Michelle ; Kuti, Joseph L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3863-86bb293bd04f15becc5512d75d9fea491e74f20272bbe287f560202b8f53fedc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Bronchoalveolar Lavage Fluid - microbiology</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>General aspects</topic><topic>Hospital Mortality</topic><topic>Hospitals, Teaching</topic><topic>Human infectious diseases. Experimental studies and models</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumonia, Ventilator-Associated - complications</topic><topic>Pneumonia, Ventilator-Associated - diagnosis</topic><topic>Pneumonia, Ventilator-Associated - drug therapy</topic><topic>Retrospective Studies</topic><topic>Superinfection - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Raman, Kirthana</creatorcontrib><creatorcontrib>Nailor, Michael D</creatorcontrib><creatorcontrib>Nicolau, David P</creatorcontrib><creatorcontrib>Aslanzadeh, Jaber</creatorcontrib><creatorcontrib>Nadeau, Michelle</creatorcontrib><creatorcontrib>Kuti, Joseph L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Raman, Kirthana</au><au>Nailor, Michael D</au><au>Nicolau, David P</au><au>Aslanzadeh, Jaber</au><au>Nadeau, Michelle</au><au>Kuti, Joseph L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2013-07</date><risdate>2013</risdate><volume>41</volume><issue>7</issue><spage>1656</spage><epage>1663</epage><pages>1656-1663</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVES:Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negative quantitative bronchoscopy cultures, we compared antibiotic utilization and mortality in empirically treated, culture-negative ventilator-associated pneumonia patients whose antibiotic discontinuation was early versus late.
DESIGN:Retrospective, observational cohort study.
SETTING:Eight hundred sixty-seven bed, tertiary care, teaching hospital in Hartford, CT.
PATIENTS:Eighty-nine patients with clinically suspected ventilator-associated pneumonia and a negative (<10 colony forming units/mL) quantitative bronchoscopy culture between January 2009 and March 2012. Early discontinuation patients (n = 40) were defined as those who had all antibiotic therapy stopped within one day of final negative culture report, whereas late discontinuation patients (n = 49) had antibiotics stopped later than one day.
MEASUREMENTS:Univariate analyses assessed mortality, antibiotic duration, and frequency of superinfections. Multivariate logistic regression was performed to assess the effect of early discontinuation on hospital mortality.
RESULTS:Patients had a mean ± SD Acute Physiology and Chronic Health Evaluation II score of 26.0 ± 6.0. Mortality was not different between early discontinuation (25.0%) and late discontinuation (30.6%) patients (p = 0.642). Antibiotic duration (days) was also not different for patients who died vs. those who survived (Median [interquartile range]3 [1–7.5] vs. 3 [1.75–6.25], respectively, p = 0.87), and when controlling for baseline characteristics and symptom resolution, only Acute Physiology and Chronic Health Evaluation II score was associated with hospital mortality on multivariate analyses. There were fewer superinfections (22.5% vs. 42.9%, p = 0.008), respiratory superinfections (10.0% vs. 28.6%, p = 0.036), and multidrug resistant superinfections (7.5% vs. 35.7%, p = 0.003), in early discontinuation compared with late discontinuation patients.
CONCLUSIONS:In this severely ill population with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoalveolar lavage cultures, early discontinuation of antibiotics did not affect mortality and was associated with a lower frequency of MDR superinfections.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>23528805</pmid><doi>10.1097/CCM.0b013e318287f713</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use APACHE Biological and medical sciences Bronchoalveolar Lavage Fluid - microbiology Drug Administration Schedule Female General aspects Hospital Mortality Hospitals, Teaching Human infectious diseases. Experimental studies and models Humans Infectious diseases Intensive care medicine Male Medical sciences Middle Aged Pneumonia, Ventilator-Associated - complications Pneumonia, Ventilator-Associated - diagnosis Pneumonia, Ventilator-Associated - drug therapy Retrospective Studies Superinfection - etiology |
| title | Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures |
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