Journal of Critical Care
Volume 23, Issue 1 , Pages 82-90, March 2008

The safety of targeted antibiotic therapy for ventilator-associated pneumonia: A multicenter observational study☆

  • Ari R. Joffe, MD, FRCPC

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada T6G 2B7
    • ,
  • John Muscedere, MD, FRCPC

      Affiliations

    • Department of Medicine, Queen's University, Kingston, Ontario, Canada K7L 2V7
    • ,
  • John C. Marshall, MD

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada M5B 1W8
    • ,
  • Yinghua Su, MSc

      Affiliations

    • Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7
    • ,
  • Daren K. Heyland, MD, FRCPC, MSc

      Affiliations

    • Department of Medicine, Queen's University, Kingston, Ontario, Canada K7L 2V7
    • Corresponding Author InformationCorresponding author. Tel.: +1 613 549 6666x3339; fax: +1 613 548 1351.
    • ,
  • For the Canadian Critical Care Trials Group

Abstract 

Purpose

The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP).

Materials and Methods

This was a secondary analysis from a multicenter trial of 740 patients with suspected VAP randomized to bronchoscopy or endotracheal aspirate cultures; all received empirical broad-spectrum antibiotics. Patients were grouped by whether they received TT, defined as tailoring or discontinuing antibiotics in response to enrolment culture results.

Results

For patients with a positive culture (n = 412), baseline demographics, clinical progression of infection and multiple organ dysfunction scores (MODS), and mortality were similar for those on TT (n = 320) or those who did not receive TT (NoTT) (n = 92). The TT group had more days alive and off broad-spectrum antibiotics (14.5 vs 13.2, P = .04). In patients with a negative culture (n = 327), those on TT (n = 230) had similar baseline demographics, less frequent final adjudicated diagnosis of VAP (63.0% vs 76.3%, P = .02), and less severe clinical progression of infection and MODS compared with NoTT (n = 97). The TT group had more days alive and off broad-spectrum antibiotics (15.9 vs 13.1, P < .001), lower δ MODS (2.0 vs 3.0, P = .01), fewer mechanical ventilation days (9.8 vs 14.7, P = .03), and similar mortality compared to NoTT.

Conclusions

Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.

Keywords: Ventilator-associated pneumonia, Targeted antibiotic therapy, Antibiotics

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☆ The clinical trial was supported by grants from the Canadian Institutes of Health Research, Ottawa, ON, Canada and Physicians' Services Inc., ON, Canada; and by the unrestricted grants from AstraZeneca, Mississauga, ON, Canada, and Bayer, Toronto, ON, Canada.

PII: S0883-9441(08)00006-3

doi:10.1016/j.jcrc.2007.12.006

Journal of Critical Care
Volume 23, Issue 1 , Pages 82-90, March 2008

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