Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial
CONTEXT The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown. Shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care unit (ICU). OBJECTIVE To determine whether 8 days is as effective as 15...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2003-11, Vol.290 (19), p.2588-2598 |
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| creator | Chastre, Jean Wolff, Michel Fagon, Jean-Yves Chevret, Sylvie Thomas, Franck Wermert, Delphine Clementi, Eva Gonzalez, Jesus Jusserand, Dominique Asfar, Pierre Perrin, Dominique Fieux, Fabienne Aubas, Sylvie for the PneumA Trial Group |
| description | CONTEXT The optimal duration of antimicrobial treatment for ventilator-associated
pneumonia (VAP) is unknown. Shortening the length of treatment may help to
contain the emergence of multiresistant bacteria in the intensive care unit
(ICU). OBJECTIVE To determine whether 8 days is as effective as 15 days of antibiotic
treatment of patients with microbiologically proven VAP. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, double-blind (until day 8) clinical trial conducted
in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP
by quantitative culture results of bronchoscopic specimens and who had received
initial appropriate empirical antimicrobial therapy were enrolled between
May 1999 and June 2002. INTERVENTION A total of 197 patients were randomly assigned to receive 8 days and
204 to receive 15 days of therapy with an antibiotic regimen selected by the
treating physician. MAIN OUTCOME MEASURES Primary outcome measures—death from any cause, microbiologically
documented pulmonary infection recurrence, and antibiotic-free days—were
assessed 28 days after VAP onset and analyzed on an intent-to-treat basis. RESULTS Compared with patients treated for 15 days, those treated for 8 days
had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence
interval [CI], −3.7% to 6.9%) nor more recurrent infections (28.9% vs
26.0%; difference, 2.9%; 90% CI, −3.2% to 9.1%), but they had more mean
(SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P |
| doi_str_mv | 10.1001/jama.290.19.2588 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_71380633</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>197644</ama_id><sourcerecordid>71380633</sourcerecordid><originalsourceid>FETCH-LOGICAL-a282t-bab7fb4177b65260f5a4c42033fe5086da287e8eb820974ed25d740ab8b72ad83</originalsourceid><addsrcrecordid>eNpd0Utr3DAQAGBRGprNpvfmEkQhuXmrpyXnZjZPCKSEba9mZMtUiy1tJbuw_fVVyJZA5jKM9DEMMwh9oWRFCaHftjDCilW5qlZMav0BLajkuuCy0h_RgpBKF0pocYxOUtqSHJSrT-iYipJJzssFiusw7iC6FDwOPdb4T8JU4mvYp5e69pMzLkyuxZtfNsJuj_sQ8U-b3weYQizqlELrYLId_u7tPAbvADuP624epnSFa_wMvguj-5vFJjoYTtFRD0Oynw95iX7c3mzW98Xj093Dun4sgGk2FQaM6o2gSplSspL0EkQrGOG8t5LosstMWW2NZqRSwnZMdkoQMNooBp3mS3T52ncXw-_ZpqkZXWrtMIC3YU6NolyTkvMMv76D2zBHn2drGH1BRLCMzg9oNqPtml10I8R983-VGVwcAKQWhj6Cb116c5JVTAuZ3dmry7d7-61UKQT_BycJih8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211380042</pqid></control><display><type>article</type><title>Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Chastre, Jean ; Wolff, Michel ; Fagon, Jean-Yves ; Chevret, Sylvie ; Thomas, Franck ; Wermert, Delphine ; Clementi, Eva ; Gonzalez, Jesus ; Jusserand, Dominique ; Asfar, Pierre ; Perrin, Dominique ; Fieux, Fabienne ; Aubas, Sylvie ; for the PneumA Trial Group</creator><creatorcontrib>Chastre, Jean ; Wolff, Michel ; Fagon, Jean-Yves ; Chevret, Sylvie ; Thomas, Franck ; Wermert, Delphine ; Clementi, Eva ; Gonzalez, Jesus ; Jusserand, Dominique ; Asfar, Pierre ; Perrin, Dominique ; Fieux, Fabienne ; Aubas, Sylvie ; for the PneumA Trial Group ; PneumA Trial Group</creatorcontrib><description>CONTEXT The optimal duration of antimicrobial treatment for ventilator-associated
pneumonia (VAP) is unknown. Shortening the length of treatment may help to
contain the emergence of multiresistant bacteria in the intensive care unit
(ICU). OBJECTIVE To determine whether 8 days is as effective as 15 days of antibiotic
treatment of patients with microbiologically proven VAP. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, double-blind (until day 8) clinical trial conducted
in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP
by quantitative culture results of bronchoscopic specimens and who had received
initial appropriate empirical antimicrobial therapy were enrolled between
May 1999 and June 2002. INTERVENTION A total of 197 patients were randomly assigned to receive 8 days and
204 to receive 15 days of therapy with an antibiotic regimen selected by the
treating physician. MAIN OUTCOME MEASURES Primary outcome measures—death from any cause, microbiologically
documented pulmonary infection recurrence, and antibiotic-free days—were
assessed 28 days after VAP onset and analyzed on an intent-to-treat basis. RESULTS Compared with patients treated for 15 days, those treated for 8 days
had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence
interval [CI], −3.7% to 6.9%) nor more recurrent infections (28.9% vs
26.0%; difference, 2.9%; 90% CI, −3.2% to 9.1%), but they had more mean
(SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P<.001). The number of mechanical ventilation–free days, the
number of organ failure–free days, the length of ICU stay, and mortality
rates on day 60 for the 2 groups did not differ. Although patients with VAP
caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when
antimicrobial therapy lasted only 8 days, they did have a higher pulmonary
infection-recurrence rate compared with those receiving 15 days of treatment
(40.6% vs 25.4%; difference, 15.2%, 90% CI, 3.9%-26.6%). Among patients who
developed recurrent infections, multiresistant pathogens emerged less frequently
in those who had received 8 days of antibiotics (42.1% vs 62.0% of pulmonary
recurrences, P = .04). CONCLUSIONS Among patients who had received appropriate initial empirical therapy,
with the possible exception of those developing nonfermenting gram-negative
bacillus infections, comparable clinical effectiveness against VAP was obtained
with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic
use.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.290.19.2588</identifier><identifier>PMID: 14625336</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; Bronchoscopy ; Clinical trials ; Cross Infection - drug therapy ; Cross Infection - etiology ; Double-Blind Method ; Drug Administration Schedule ; Drug therapy ; Female ; Humans ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Patients ; Pharmacology. Drug treatments ; Pneumonia ; Pneumonia, Bacterial - diagnosis ; Pneumonia, Bacterial - drug therapy ; Pneumonia, Bacterial - etiology ; Prospective Studies ; Respiration, Artificial - adverse effects ; Treatment Outcome</subject><ispartof>JAMA : the journal of the American Medical Association, 2003-11, Vol.290 (19), p.2588-2598</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright American Medical Association Nov 19, 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.290.19.2588$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.290.19.2588$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15292845$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14625336$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chastre, Jean</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Fagon, Jean-Yves</creatorcontrib><creatorcontrib>Chevret, Sylvie</creatorcontrib><creatorcontrib>Thomas, Franck</creatorcontrib><creatorcontrib>Wermert, Delphine</creatorcontrib><creatorcontrib>Clementi, Eva</creatorcontrib><creatorcontrib>Gonzalez, Jesus</creatorcontrib><creatorcontrib>Jusserand, Dominique</creatorcontrib><creatorcontrib>Asfar, Pierre</creatorcontrib><creatorcontrib>Perrin, Dominique</creatorcontrib><creatorcontrib>Fieux, Fabienne</creatorcontrib><creatorcontrib>Aubas, Sylvie</creatorcontrib><creatorcontrib>for the PneumA Trial Group</creatorcontrib><creatorcontrib>PneumA Trial Group</creatorcontrib><title>Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT The optimal duration of antimicrobial treatment for ventilator-associated
pneumonia (VAP) is unknown. Shortening the length of treatment may help to
contain the emergence of multiresistant bacteria in the intensive care unit
(ICU). OBJECTIVE To determine whether 8 days is as effective as 15 days of antibiotic
treatment of patients with microbiologically proven VAP. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, double-blind (until day 8) clinical trial conducted
in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP
by quantitative culture results of bronchoscopic specimens and who had received
initial appropriate empirical antimicrobial therapy were enrolled between
May 1999 and June 2002. INTERVENTION A total of 197 patients were randomly assigned to receive 8 days and
204 to receive 15 days of therapy with an antibiotic regimen selected by the
treating physician. MAIN OUTCOME MEASURES Primary outcome measures—death from any cause, microbiologically
documented pulmonary infection recurrence, and antibiotic-free days—were
assessed 28 days after VAP onset and analyzed on an intent-to-treat basis. RESULTS Compared with patients treated for 15 days, those treated for 8 days
had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence
interval [CI], −3.7% to 6.9%) nor more recurrent infections (28.9% vs
26.0%; difference, 2.9%; 90% CI, −3.2% to 9.1%), but they had more mean
(SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P<.001). The number of mechanical ventilation–free days, the
number of organ failure–free days, the length of ICU stay, and mortality
rates on day 60 for the 2 groups did not differ. Although patients with VAP
caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when
antimicrobial therapy lasted only 8 days, they did have a higher pulmonary
infection-recurrence rate compared with those receiving 15 days of treatment
(40.6% vs 25.4%; difference, 15.2%, 90% CI, 3.9%-26.6%). Among patients who
developed recurrent infections, multiresistant pathogens emerged less frequently
in those who had received 8 days of antibiotics (42.1% vs 62.0% of pulmonary
recurrences, P = .04). CONCLUSIONS Among patients who had received appropriate initial empirical therapy,
with the possible exception of those developing nonfermenting gram-negative
bacillus infections, comparable clinical effectiveness against VAP was obtained
with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic
use.</description><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibacterial agents</subject><subject>Antibiotics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Biological and medical sciences</subject><subject>Bronchoscopy</subject><subject>Clinical trials</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - etiology</subject><subject>Double-Blind Method</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pharmacology. Drug treatments</subject><subject>Pneumonia</subject><subject>Pneumonia, Bacterial - diagnosis</subject><subject>Pneumonia, Bacterial - drug therapy</subject><subject>Pneumonia, Bacterial - etiology</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Treatment Outcome</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0Utr3DAQAGBRGprNpvfmEkQhuXmrpyXnZjZPCKSEba9mZMtUiy1tJbuw_fVVyJZA5jKM9DEMMwh9oWRFCaHftjDCilW5qlZMav0BLajkuuCy0h_RgpBKF0pocYxOUtqSHJSrT-iYipJJzssFiusw7iC6FDwOPdb4T8JU4mvYp5e69pMzLkyuxZtfNsJuj_sQ8U-b3weYQizqlELrYLId_u7tPAbvADuP624epnSFa_wMvguj-5vFJjoYTtFRD0Oynw95iX7c3mzW98Xj093Dun4sgGk2FQaM6o2gSplSspL0EkQrGOG8t5LosstMWW2NZqRSwnZMdkoQMNooBp3mS3T52ncXw-_ZpqkZXWrtMIC3YU6NolyTkvMMv76D2zBHn2drGH1BRLCMzg9oNqPtml10I8R983-VGVwcAKQWhj6Cb116c5JVTAuZ3dmry7d7-61UKQT_BycJih8</recordid><startdate>20031119</startdate><enddate>20031119</enddate><creator>Chastre, Jean</creator><creator>Wolff, Michel</creator><creator>Fagon, Jean-Yves</creator><creator>Chevret, Sylvie</creator><creator>Thomas, Franck</creator><creator>Wermert, Delphine</creator><creator>Clementi, Eva</creator><creator>Gonzalez, Jesus</creator><creator>Jusserand, Dominique</creator><creator>Asfar, Pierre</creator><creator>Perrin, Dominique</creator><creator>Fieux, Fabienne</creator><creator>Aubas, Sylvie</creator><creator>for the PneumA Trial Group</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20031119</creationdate><title>Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial</title><author>Chastre, Jean ; Wolff, Michel ; Fagon, Jean-Yves ; Chevret, Sylvie ; Thomas, Franck ; Wermert, Delphine ; Clementi, Eva ; Gonzalez, Jesus ; Jusserand, Dominique ; Asfar, Pierre ; Perrin, Dominique ; Fieux, Fabienne ; Aubas, Sylvie ; for the PneumA Trial Group</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a282t-bab7fb4177b65260f5a4c42033fe5086da287e8eb820974ed25d740ab8b72ad83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibacterial agents</topic><topic>Antibiotics</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Biological and medical sciences</topic><topic>Bronchoscopy</topic><topic>Clinical trials</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - etiology</topic><topic>Double-Blind Method</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pharmacology. Drug treatments</topic><topic>Pneumonia</topic><topic>Pneumonia, Bacterial - diagnosis</topic><topic>Pneumonia, Bacterial - drug therapy</topic><topic>Pneumonia, Bacterial - etiology</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chastre, Jean</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Fagon, Jean-Yves</creatorcontrib><creatorcontrib>Chevret, Sylvie</creatorcontrib><creatorcontrib>Thomas, Franck</creatorcontrib><creatorcontrib>Wermert, Delphine</creatorcontrib><creatorcontrib>Clementi, Eva</creatorcontrib><creatorcontrib>Gonzalez, Jesus</creatorcontrib><creatorcontrib>Jusserand, Dominique</creatorcontrib><creatorcontrib>Asfar, Pierre</creatorcontrib><creatorcontrib>Perrin, Dominique</creatorcontrib><creatorcontrib>Fieux, Fabienne</creatorcontrib><creatorcontrib>Aubas, Sylvie</creatorcontrib><creatorcontrib>for the PneumA Trial Group</creatorcontrib><creatorcontrib>PneumA Trial Group</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>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chastre, Jean</au><au>Wolff, Michel</au><au>Fagon, Jean-Yves</au><au>Chevret, Sylvie</au><au>Thomas, Franck</au><au>Wermert, Delphine</au><au>Clementi, Eva</au><au>Gonzalez, Jesus</au><au>Jusserand, Dominique</au><au>Asfar, Pierre</au><au>Perrin, Dominique</au><au>Fieux, Fabienne</au><au>Aubas, Sylvie</au><au>for the PneumA Trial Group</au><aucorp>PneumA Trial Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2003-11-19</date><risdate>2003</risdate><volume>290</volume><issue>19</issue><spage>2588</spage><epage>2598</epage><pages>2588-2598</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT The optimal duration of antimicrobial treatment for ventilator-associated
pneumonia (VAP) is unknown. Shortening the length of treatment may help to
contain the emergence of multiresistant bacteria in the intensive care unit
(ICU). OBJECTIVE To determine whether 8 days is as effective as 15 days of antibiotic
treatment of patients with microbiologically proven VAP. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized, double-blind (until day 8) clinical trial conducted
in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP
by quantitative culture results of bronchoscopic specimens and who had received
initial appropriate empirical antimicrobial therapy were enrolled between
May 1999 and June 2002. INTERVENTION A total of 197 patients were randomly assigned to receive 8 days and
204 to receive 15 days of therapy with an antibiotic regimen selected by the
treating physician. MAIN OUTCOME MEASURES Primary outcome measures—death from any cause, microbiologically
documented pulmonary infection recurrence, and antibiotic-free days—were
assessed 28 days after VAP onset and analyzed on an intent-to-treat basis. RESULTS Compared with patients treated for 15 days, those treated for 8 days
had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence
interval [CI], −3.7% to 6.9%) nor more recurrent infections (28.9% vs
26.0%; difference, 2.9%; 90% CI, −3.2% to 9.1%), but they had more mean
(SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P<.001). The number of mechanical ventilation–free days, the
number of organ failure–free days, the length of ICU stay, and mortality
rates on day 60 for the 2 groups did not differ. Although patients with VAP
caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when
antimicrobial therapy lasted only 8 days, they did have a higher pulmonary
infection-recurrence rate compared with those receiving 15 days of treatment
(40.6% vs 25.4%; difference, 15.2%, 90% CI, 3.9%-26.6%). Among patients who
developed recurrent infections, multiresistant pathogens emerged less frequently
in those who had received 8 days of antibiotics (42.1% vs 62.0% of pulmonary
recurrences, P = .04). CONCLUSIONS Among patients who had received appropriate initial empirical therapy,
with the possible exception of those developing nonfermenting gram-negative
bacillus infections, comparable clinical effectiveness against VAP was obtained
with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic
use.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>14625336</pmid><doi>10.1001/jama.290.19.2588</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2003-11, Vol.290 (19), p.2588-2598 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_71380633 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Adult Aged Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use Antibacterial agents Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Biological and medical sciences Bronchoscopy Clinical trials Cross Infection - drug therapy Cross Infection - etiology Double-Blind Method Drug Administration Schedule Drug therapy Female Humans Intensive Care Units Male Medical sciences Middle Aged Patients Pharmacology. Drug treatments Pneumonia Pneumonia, Bacterial - diagnosis Pneumonia, Bacterial - drug therapy Pneumonia, Bacterial - etiology Prospective Studies Respiration, Artificial - adverse effects Treatment Outcome |
| title | Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults: A Randomized Trial |
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