Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high-risk trauma patients

Results of a double-blind randomized study

Jeffrey A. Claridge, Norma M. Edwards, Joseph Swanson, Timothy C. Fabian, Jordan A. Weinberg, G Christopher Wood, Martin Croce

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Ventilator-associated pneumonia (VAP) is a frequent complication during recovery of severely traumatized patients. The primary objective of this study was to determine if prophylactic administration of aerosolized ceftazidime reduced the incidence of VAP in high-risk injured patients without altering the incidence of other infectious complications. Patients and Methods: This was a single-institution double-blind, randomized trial that compared a seven-day course of aerosolized ceftazidime with placebo. Intubated high-risk patients admitted to the trauma intensive care unit at a large regional trauma center between February 2003 and September 2005 were eligible for enrollment. The main outcome evaluated was the incidence of VAP at two weeks and 30 days. The incidences of multi-drug-resistant infections and other infectious complications were secondary outcomes. Results: A total of 105 patients were randomized, resulting in 52 patients in the placebo arm and 53 patients in the ceftazidime arm. There was no statistical difference between the groups with regard to demographic data, injury severity, calculated risk of VAP, or the number of doses received. In the intention-to-treat analysis, the incidence of VAP at two weeks was 24/52 (46%) in the placebo group and 21/53 (40%) in the ceftazidime group. The number of patients with VAP at 30 days was 26/52 (50%) in the placebo group and 26/53 (49%) in the ceftazidime group. There was no statistical difference in the development of multi-drug-resistant VAP or other infectious complications in the two groups. Conclusion: The use of aerosolized ceftazidime did not reduce the rate of VAP in high-risk patients admitted after traumatic injury, but neither did it increase the incidence of other infectious complications. Routine use of prophylactic aerosolized ceftazidime to prevent VAP in trauma patients cannot be recommended.

Original languageEnglish (US)
Pages (from-to)83-90
Number of pages8
JournalSurgical Infections
Volume8
Issue number1
DOIs
StatePublished - Feb 1 2007

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Ventilator-Associated Pneumonia
Ceftazidime
Double-Blind Method
Wounds and Injuries
Incidence
Placebos
Intention to Treat Analysis
Trauma Centers
Pharmaceutical Preparations
Intensive Care Units
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high-risk trauma patients : Results of a double-blind randomized study. / Claridge, Jeffrey A.; Edwards, Norma M.; Swanson, Joseph; Fabian, Timothy C.; Weinberg, Jordan A.; Wood, G Christopher; Croce, Martin.

In: Surgical Infections, Vol. 8, No. 1, 01.02.2007, p. 83-90.

Research output: Contribution to journalArticle

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title = "Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high-risk trauma patients: Results of a double-blind randomized study",
abstract = "Background: Ventilator-associated pneumonia (VAP) is a frequent complication during recovery of severely traumatized patients. The primary objective of this study was to determine if prophylactic administration of aerosolized ceftazidime reduced the incidence of VAP in high-risk injured patients without altering the incidence of other infectious complications. Patients and Methods: This was a single-institution double-blind, randomized trial that compared a seven-day course of aerosolized ceftazidime with placebo. Intubated high-risk patients admitted to the trauma intensive care unit at a large regional trauma center between February 2003 and September 2005 were eligible for enrollment. The main outcome evaluated was the incidence of VAP at two weeks and 30 days. The incidences of multi-drug-resistant infections and other infectious complications were secondary outcomes. Results: A total of 105 patients were randomized, resulting in 52 patients in the placebo arm and 53 patients in the ceftazidime arm. There was no statistical difference between the groups with regard to demographic data, injury severity, calculated risk of VAP, or the number of doses received. In the intention-to-treat analysis, the incidence of VAP at two weeks was 24/52 (46{\%}) in the placebo group and 21/53 (40{\%}) in the ceftazidime group. The number of patients with VAP at 30 days was 26/52 (50{\%}) in the placebo group and 26/53 (49{\%}) in the ceftazidime group. There was no statistical difference in the development of multi-drug-resistant VAP or other infectious complications in the two groups. Conclusion: The use of aerosolized ceftazidime did not reduce the rate of VAP in high-risk patients admitted after traumatic injury, but neither did it increase the incidence of other infectious complications. Routine use of prophylactic aerosolized ceftazidime to prevent VAP in trauma patients cannot be recommended.",
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AB - Background: Ventilator-associated pneumonia (VAP) is a frequent complication during recovery of severely traumatized patients. The primary objective of this study was to determine if prophylactic administration of aerosolized ceftazidime reduced the incidence of VAP in high-risk injured patients without altering the incidence of other infectious complications. Patients and Methods: This was a single-institution double-blind, randomized trial that compared a seven-day course of aerosolized ceftazidime with placebo. Intubated high-risk patients admitted to the trauma intensive care unit at a large regional trauma center between February 2003 and September 2005 were eligible for enrollment. The main outcome evaluated was the incidence of VAP at two weeks and 30 days. The incidences of multi-drug-resistant infections and other infectious complications were secondary outcomes. Results: A total of 105 patients were randomized, resulting in 52 patients in the placebo arm and 53 patients in the ceftazidime arm. There was no statistical difference between the groups with regard to demographic data, injury severity, calculated risk of VAP, or the number of doses received. In the intention-to-treat analysis, the incidence of VAP at two weeks was 24/52 (46%) in the placebo group and 21/53 (40%) in the ceftazidime group. The number of patients with VAP at 30 days was 26/52 (50%) in the placebo group and 26/53 (49%) in the ceftazidime group. There was no statistical difference in the development of multi-drug-resistant VAP or other infectious complications in the two groups. Conclusion: The use of aerosolized ceftazidime did not reduce the rate of VAP in high-risk patients admitted after traumatic injury, but neither did it increase the incidence of other infectious complications. Routine use of prophylactic aerosolized ceftazidime to prevent VAP in trauma patients cannot be recommended.

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