Late onset ventilator associated pneumonia (VAP) caused by enteric gram negative bacteria has an attributable mortality ranging from 10-60%. This high mortality rate despite the use of multiple IV antibiotics has led to speculation regarding the inability of IV antibiotics to reach the lungs. Data regarding the use of aerosolized tobramycin (TOBI) in VAP is sparce.
We performed a retrospective analysis of a case controlled utilization study of TOBI in VAP caused by enteric gram negative bacteria (microbiologically documented). Trauma patients diagnosed with VAP (by quantitative microbiologic techniques) were pulled from our trauma registry database and a detailed chart review was performed. All patients received either 2 IV antibiotics (Control group-n=25) or 1 IV antibiotic and TOBI (Study group-n=24). Demographic and outcome data were collected and analyzed for statistical significance.
Demographic data (gender, age, injury severity score (ISS), and APACHE-2 score at the time of diagnosis of VAP) were statistically comperable between the control and study groups (Table 1)
Demographic dataMale/Female ratioAgeISSAPACHE-2Control group n=2520/537 ± 1825.1 ± 9.523.7 ± 4.9Study group n=2417/744 ± 1922.8 ± 12.322.5 ± 5.6. Outcome data (ICU length of stay, ventilator days, and hospital length of stay) showed significant reductions. Overall survival to hosptal discharge was not signifcantly different (Table 2)
Outcome dataICU Length of Stay (days)Ventilator daysHospital Length of Stay (days)Survival (%)Control group n=2516.0 ± 7.115.4 ± 6.521.8 ± 7.480Study group11.1 ± 5.49.9 ± 3.316.3 ± 5.491 n=24*p<0.05*p<0.05*p<0.05CONCLUSIONS: In clinically matched trauma patients with VAP caused by enteric gram negative bacteria the use of aerosolized tobramycin (TOBI) seems to improve clinical outcomes.
TOBI may be a useful tool in the treatment of VAP caused by enteric gram negative bacteria.
A. Chendrasekhar, CHIRON, discussion of product research or unlabeled uses of product.