Journal of Critical Care
Volume 23, Issue 1 , Pages 58-63 , March 2008

Previous cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: Secondary analysis from a randomized trial

  • Kevin M. Sanders

      Affiliations

    • Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada M5T 2S8
    • ,
  • Neill K.J. Adhikari

      Affiliations

    • Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada M5T 2S8
    • ,
  • Jan O. Friedrich

      Affiliations

    • Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada M5T 2S8
    • ,
  • Andrew Day

      Affiliations

    • Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Queens University, Kingston, Ontario, Canada K7L 2V7
    • ,
  • Xuran Jiang

      Affiliations

    • Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Queens University, Kingston, Ontario, Canada K7L 2V7
    • ,
  • Daren Heyland

      Affiliations

    • Department of Medicine, Clinical Evaluation Research Unit, Kingston General Hospital, Queens 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. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903
  2. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med. 1999;159(4 Pt 1):1249–1256
  3. Fagon JY, Chastre J, Vuagnat A, et al. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA. 1996;275(11):866–869
  4. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115–2121
  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(1):262–268
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  7. American Thoracic Society, Infectious Diseases Society of America . Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416
  8. Rello J, Torres A, Ricart M, et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med. 1994;150(6 Pt 1):1545–1549
  9. Raymond DP, Pelletier SJ, Crabtree TD, et al. Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients. Crit Care Med. 2003;31(4):1035–1041
  10. Michel F, Franceschini B, Berger P, et al. Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures. Chest. 2005;127(2):589–597
  11. Flanagan PG, Findlay GP, Magee JT, et al. The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages. Intensive Care Med. 2000;26(1):20–30
  12. Delclaux C, Roupie E, Blot F, et al. Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome: incidence and diagnosis. Am J Respir Crit Care Med. 1997;156(4 Pt 1):1092–1098
  13. Bouza E, Perez A, Munoz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med. 2003;31(7):1964–1970
  14. Hayon J, Figliolini C, Combes A, et al. Role of serial routine microbiologic culture results in the initial management of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(1):41–46
  15. Canadian Critical Care Trials Group . A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355(25):2619–2630
  16. Heyland DK, Dodek P, Muscedere J, et al. Randomized trial of combination versus monotherapy for the empiric treatment of ventilator associated pneumonia. Crit Care Med. 2008;36(2):1–8
  17. Marshall JC, Cook DJ, Christou NV, et al. Multiple Organ Dysfunction Score: a reliable [18] descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–1652
  18. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829

☆ Supported by grants from the Canadian Institutes of Health Research and Physicians' Services, Inc, of Ontario, and by unrestricted grants from AstraZeneca and Bayer.

PII: S0883-9441(08)00030-0

doi: 10.1016/j.jcrc.2008.01.009

Journal of Critical Care
Volume 23, Issue 1 , Pages 58-63 , March 2008

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