Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial.

Autor: Bouglé, Adrien, Tuffet, Sophie, Federici, Laura, Leone, Marc, Monsel, Antoine, Dessalle, Thomas, Amour, Julien, Dahyot-Fizelier, Claire, Barbier, François, Luyt, Charles-Edouard, Langeron, Olivier, Cholley, Bernard, Pottecher, Julien, Hissem, Tarik, Lefrant, Jean-Yves, Veber, Benoit, Legrand, Matthieu, Demoule, Alexandre, Kalfon, Pierre, Constantin, Jean-Michel
Zdroj: Intensive Care Medicine; Jul2022, Vol. 48 Issue 7, p841-849, 9p, 1 Diagram, 3 Charts, 1 Graph
Abstrakt: Purpose: Duration of antibiotic therapy for ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA) remains uncertain. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). Methods: We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. Results: The study was stopped after 24 months due to slow inclusion rate. In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) −1.9%–21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. Conclusions: Our study failed to show the non-inferiority of a short duration of antibiotics in the treatment of PA-VAP, compared to a long duration. The short duration strategy may be associated to an increase of PA-VAP recurrence. However, the lack of power limits the interpretation of this study. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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