| Autor: |
Alexander, Kaitlin M., Davis, S. Noelle, Butts, C. Caleb, Morgan, John, Croft, Leah K., Lee, Yann-leei L., Kinnard, Christopher M., Polite, Nathan M., Mbaka, Maryann I., Williams, Ashley Y., Barrington, Robert A., Audia, Jonathon P., Simmons, Jon D. |
| Zdroj: |
The American Surgeon; November 2023, Vol. 89 Issue: 11 p4536-4541, 6p |
| Abstrakt: |
Introduction Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant Staphylococcus aureus(MRSA) and Pseudomonas aeruginosainfections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP.Methods This retrospective cohort study included adult trauma patients with the diagnosis of VAP. The primary outcome was the presence of MRSA and/or P. aeruginosain patients with early- and late-VAP. Secondary outcomes included the bacterial susceptibility of pathogens to methicillin, ampicillin/sulbactam, ceftriaxone, piperacillin/tazobactam, and cefepime. Intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days, and in-hospital mortality were also collected.Results 164 patients met inclusion criteria, and 208 organisms (n = 90 early vs n = 118 late) were identified by respiratory culture. The incidence of MRSA and P. aeruginosain early-VAP was 7.7% (7/90) and 5.6% (5/90), respectively. The susceptibility of bacteria causing early-VAP to ampicillin/sulbactam and ceftriaxone was 73.3% (66/90) and 83.3% (75/90), respectively. Ventilator-free days at 30 days was similar between groups (P= .649). Patients with late-VAP spent more time in the ICU (P= .040); however, in-hospital mortality was higher in the early-VAP group (P= .012).Conclusions Ampicillin/sulbactam or ceftriaxone monotherapy did not provide reliable broad-spectrum coverage for early-VAP in our cohort. These findings highlight the importance of each institution performing a similar analysis to ensure adequate initial treatment of VAP. |
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