To assess the impact of an antibiotic discontinuation protocol on the duration of antibiotic therapy for ventilator-associated pneumonia (VAP).
A randomized study of patients requiring mechanical ventilation in the medical ICU setting. Antibiotic therapy that was empirically started for VAP was discontinued when the white blood cell count decreased to less than 10,000 per mm3, the temperature was less than or equal to 38.3 degrees C, and the PaO2/FiO2 ratio was greater than or equal to 250 in the protocol arm. All patients were treated with an initial antibiotic regimen containing cefepime (plus ciprofloxacin or gentamicin) for gram-negative bacilli and vancomycin or linezolid for Staphylococcus aureus.
All patients received antibiotic therapy to which the isolated bacteria associated with VAP were sensitive in vitro. 25 patients were randomized to the protocol intervention and 30 to standard medical care. The duration of antibiotic therapy was statistically shorter among the patients managed with the antibiotic discontinuation protocol (4.8 +/− 3.7 days versus 8.0 +/− 6.8 days; P = 0.02). Hospital length of stay (16.3 +/− 32.1 days versus 19.2 +/− 18.2 days; P = 0.817) and mortality (28.0% versus 33.3%; P = 0.67) were not statistically different between the two study groups.CONCLUSIONS: A protocol aimed at providing objective guidance for the discontinuation of antibiotic therapy for VAP resulted in shorter durations of antibiotic administration.
ICU practitioners should develop objective criteria for the discontinuation of empiric antibiotic therapy begun for patients with suspected VAP.
M.H. Kollef, Elan, grant monies; Pharmacia, grant monies; Bayer, grant monies.