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

References 

  1. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33:2184–2193
  2. Muscedere JG, Martin CM, Heyland DK. The burden of illness from ventilator associated pneumonia in Canada. Proc Am Thorac Soc. 2006;3:A526;[abstr]
  3. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med. 1999;159:1249–1256
  4. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416
  5. Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–268
  6. Luna CM, Vujacich P, Niederman M, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676–685
  7. Kollef MH, Ward S. The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest. 1998;113:412–420
  8. Hoffken G, Niederman MS. Nosocomial pneumonia: the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest. 2002;122:2183–2196
  9. Sandiumenge A, Diaz E, Bodi M, et al. Therapy of ventilator-associated pneumonia: a patient-based approach based on the ten rules of the “The Tarragona Strategy”. Intensive Care Med. 2003;29:876–883
  10. European Task Force on Ventilator Associated Pneumonia . Ventilator-associated pneumonia. Eur Respir J. 2001;17:1034–1045
  11. Rello J, Paiva JA, Baraibar J, et al. International conference for the development of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest. 2001;120:955–970
  12. Mehta RM, Niederman MS. Nosocomial pneumonia in the intensive care unit: controversies and dilemmas. J Intensive Care Med. 2003;18:175–188
  13. Niederman MS. De-escalation therapy in ventilator-associated pneumonia. Curr Opin Crit Care. 2006;12:452–457
  14. Dellit TH, Owens RC, McGtowan JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–177
  15. Chastre J, Luyt CE, Combes A, et al. Use of quantitative cultures and reduced duration of antibiotic regimens for patients with ventilator-associated pneumonia to decrease resistance in the intensive care unit. Clin Infect Dis. 2006;43:S75–S81
  16. Singh N, Rogers P, Atwood CW, et al. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162:505–511
  17. Kollef MH, Kollef KE. Antibiotic utilization and outcomes for patients with clinically suspected ventilator-associated pneumonia and negative quantitative BAL culture results. Chest. 2005;128:2706–2713
  18. Micek ST, Ward S, Fraser VJ, et al. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest. 2004;125:1791–1799
  19. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588–2598
  20. Kollef M, Micek ST. Strategies to prevent antimicrobial resistance in the intensive care unit. Crit Care Med. 2005;33:1845–1853
  21. Niederman MS. Appropriate use of antimicrobial agents: challenges and strategies for improvement. Crit Care Med. 2003;31:608–616
  22. Kollef MH, Morrow LE, Niederman MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest. 2006;129:1210–1218
  23. The Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619–2630
  24. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–1652
  25. Fujitani S, Yu VL. Quantitative cultures for diagnosing ventilator-associated pneumonia: a critique. Clin Infect Dis. 2006;43:S106–S113
  26. Dennesen PJ, van der Ven AJ, Kessels AG, et al. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med. 2001;163:1371–1375
  27. Shorr AF, Sherner JH, Jackson WL, et al. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2005;33:46–53
  28. Rello J, Vidaur L, Sandiumenge A, et al. De-escalation therapy in ventilator-associated pneumonia. Crit Care Med. 2004;32:2183–2190
  29. Ibrahim EH, Ward S, Sherman G, et al. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med. 2001;29:1109–1115
  30. Bonten MJM, Bergmans DCJJ, Stobberingh EE, et al. Implementation of bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia to reduce antibiotic use. Am J Respir Crit Care Med. 1997;156:1820–1824
  31. Alvarez-Lerma F, Alvarez B, Luque P, et al. Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study. Crit Care. 2006;10:R78

☆ 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

Article Tools