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How long is enough to treat Ventilator Associated Pneumonia? A Randomized pilot study: The Latinoamerican Experience FREE TO VIEW

E. A. Maldonado-Ortiz, MD*; Michael S. Niederman, MD; Flavio Nacul, MD; Aurelio Rodríguez, MD; Stenio Ceballos, MD; Julio Osorio, MD; EAT LATINOAMERICA Study Group, NA
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Hospital de la Muje, Morelia, Mexico


Chest. 2004;126(4_MeetingAbstracts):717S-b-718S. doi:10.1378/chest.126.4_MeetingAbstracts.717S-b
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PURPOSE:  The treatment of ventilator associated pneumonia VAP is an unsettled and controversial area, with no agreement about whether the decision to stop antibiotic therapy, sometimes guided by clinical criteria or by microbiological data. Our objective is to evaluate the effect and success of early vs late discontinuation of Empirical Antibiotcs Treatment in VAP population.

METHODS:  A prospective, multicentric randomized R Latinoamerican LA study. was conducted in patients with VAP, p were R in two groups G: G=1 (abs for <8 d) and G=2 ( > 9 d). Epidemiological data, Clinical Pulmonary Infection Score CPIS at admission, 72 hrs and 8 d., APACHE II, etiology and Risk factors were recorded. EAT success was evaluated at 72 h and effect at the end of antibiotics administration.

RESULTS:  65 p were included: 31/65p, (G 1: <8d) and 34/65p, (G 2, >9d). There was not significant difference in age, APACHE II, CPIS at admission/72h and mortality. EAT success was 71% and 61.8% in G1 and G2 respectively. Antibiotics discontinuation at 8 d: G1, 21/31p, 67.7% and G2, 24/34p,70.6%. d of abs administration <8 vs >9d:G1 (6.71+1 vs 18.8+6.6 d, difference 12.0, p=0.000), G2: (6.66+1 vs 14.7+4.1d, difference 8.0, p= 0.000). When CPIS 1, 2 and 3 were compared, significant correlation between sequential decrease CPIS value and abs discontinuation was observed.

CONCLUSION:  1. Despite our limitations, The EAT Latinoamerican experience demostrated that a large cases of VAP can be resolve with just eigth d of combined antibiotic treatment. 2. No additional abs administration was necessary in p responders at 8 d. 3. Similar studies are mandatory to confirm our results.

CLINICAL IMPLICATIONS:  The correct choice of EAT reduce the prolonged administration of antibiotics and secundary effects (induce bacterial resistance, toxicity and inceased cost).

Characteristics between groups

VariablesGroup 1Group 231/65p34/65pAge (yrs)36.3±15.738.8±15APACHE II17.1±5.414.9±4.6CPIS 19.77±1.09.88±1CPIS 28.87±1.98.76±2CPIS 34.9+2.54.7+2.8EAT duration (d)10.6±6.89.0±4.3

Sequential CPIS comparation between both groups

GroupsCPIS 1- CPIS 2CPIS 1-CPIS 3OD (95% CI)p valueOD (95% CI)p valueG1 (31/65p)Responders at 8 d1.61(0.8–2.3)0.0006.38 (5.8–6.9)0.000Responders at d−0.6 (−1.5–0.30.1681.7 (4.6–3.35)0.045G 2 (34/65p)Responders at 8 d1.61 (0.85–2.38)0.0006.79(6.4–7.14)0.000Responders at d0.5 (−1.3–1.13)0.8591.2 (0.6–2.4)0.051

DISCLOSURE:  E.A. Maldonado-Ortiz, None.

Monday, October 25, 2004

10:30 AM- 12:15 PM




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