To assess potential differences in bacterial etiology of subjects with early-onset vs. late-onset ventilator associated pneumonia (VAP).
Subjects enrolled in 2004–2006 in 2 clinical studies of doripenem vs. imipenem or piperacillin/tazobactam with a diagnosis of VAP (N=500) were included in the analysis. Subjects were classified by ventilator status [early-onset VAP (<5 days of ventilation) or late-onset VAP (≥5 days of ventilation)]. Baseline demographics and bacterial etiology were analyzed by VAP status.
Late-onset VAP subjects had higher APACHE II scores [mean 16.6 vs. 15.5 (p=0.008)].There were no significant differences in CPIS, gender, age, or presence of bacteremia between groups. A total of 496 subjects had a baseline pathogen and 50% of subjects in each group had ≥2 pathogens. With the exception of S aureus, which was common in early-onset VAP, pathogens, including potentially MDR, isolated from early vs. late-onset VAP was not significantly different between groups. A baumannii or P aeruginosa resistant to any study drug was observed in 8 early vs. 10 late onset VAP subjects.
There were no significant differences in the prevalence of MDR pathogens associated with early or late-onset VAP.
VAP is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. Empiric therapy for early-onset VAP should also include agents likely to be effective for potential MDR pathogens. Further prospective studies should evaluate microbiology trends in patients with VAP.
Marcos Restrepo, Grant monies (from sources other than industry) Dr. Restrepo is supported by a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant and a CTSA Award Number (KL2 RR025766).; Employee Drs Peterson, Qin, Fisher, and Nicholson are full time employees of Ortho-McNeil Janssen Scientific Affairs, LLC; Consultant fee, speaker bureau, advisory committee, etc. Dr. Restrepo has served on advisory boards for Ortho-McNeil-Janssen and Johnson & Johnson. Dr. Restrepo has also served on speakers bureaus for Ortho-McNeil-Janssen and Johnson & Johnson.; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. This abstract reviews the bacterial etiology of early versus late-onset ventilator-associated pneumonia (VAP) from 2 large clinical trials of doripenem in the treatment of subjects with nosocomial pneumonia (NP) and/or VAP. The data is from these trials, however, this specific analysis/abstract solely reports on the baseline bacterial etiology of subjects diagnosed with either early or late-onset VAP enrolled in these studies. It does not discuss the use of doripenem in the treatment of either NP or VAP. Doripenem is currently not approved in the US for the treatment of NP or VAP. Doripenem is approved in the US for the treatment of complicated intra-abdominal infections and complicated urinary tract infections