Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia

Eric W. Mueller, Martin Croce, Bradley Boucher, Scott D. Hanes, G Christopher Wood, Joseph Swanson, Shanna K. Chennault, Timothy Fabian

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Using an arbitrary day cutoff or clinical signs to decide the duration of antibiotic therapy for ventilator-associated pneumonia (VAP) may be suboptimal for some patients. We sought to determine whether antibiotic duration for VAP can be safely abbreviated in trauma patients using repeat bronchoalveolar lavage (BAL). Methods: This was an observational case-controlled pilot study. Fifty-two patients were treated for VAP using a repeat BAL clinical pathway. Definitive antibiotic therapy for VAP was discontinued if pathogen growth was <10,000 colony forming units/mL on repeat BAL performed on day 4 of antibiotic therapy (responder), otherwise therapy was continued per managing team. A matched control group of 52 VAP patients treated before (immediately consecutive) the pathway was used for comparison. Results: Antibiotic duration in pathway patients was shorter than control patients (9.8 days ± 3.8 days vs. 16.7 days ± 7.4 days; p < 0.001), including nonfermenting gram-negative bacilli VAP (10.7 days ± 4.1 days vs. 14.4 days ± 4.2 days; p < 0.001). There were no differences in pneumonia relapse, mechanical ventilator-free intensive care unit (ICU) days, ICU-free hospital days, or mortality. Of study group isolates, 86 (82.7%) responded on repeat BAL and were treated for 8.8 days ± 3.3 days. Of these without concomitant infections (n = 65), antibiotic duration was 7.3 days ± 1.2 days compared with 14.4 days ± 2.6 days for nonresponding isolates (n = 18) (p < 0.001). Conclusions: Repeat BAL decreased the duration of antibiotic therapy for VAP in trauma patients. More adequately powered investigations are needed to appropriately determine the effects of this strategy on patient outcome.

Original languageEnglish (US)
Pages (from-to)1329-1337
Number of pages9
JournalJournal of Trauma
Volume63
Issue number6
DOIs
StatePublished - Jan 1 2007

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Ventilator-Associated Pneumonia
Bronchoalveolar Lavage
Anti-Bacterial Agents
Intensive Care Units
Therapeutics
Critical Pathways
Wounds and Injuries
Mechanical Ventilators
Bacillus
Pneumonia
Research Design
Stem Cells
Recurrence
Control Groups
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. / Mueller, Eric W.; Croce, Martin; Boucher, Bradley; Hanes, Scott D.; Wood, G Christopher; Swanson, Joseph; Chennault, Shanna K.; Fabian, Timothy.

In: Journal of Trauma, Vol. 63, No. 6, 01.01.2007, p. 1329-1337.

Research output: Contribution to journalArticle

Mueller, Eric W. ; Croce, Martin ; Boucher, Bradley ; Hanes, Scott D. ; Wood, G Christopher ; Swanson, Joseph ; Chennault, Shanna K. ; Fabian, Timothy. / Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. In: Journal of Trauma. 2007 ; Vol. 63, No. 6. pp. 1329-1337.
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abstract = "Background: Using an arbitrary day cutoff or clinical signs to decide the duration of antibiotic therapy for ventilator-associated pneumonia (VAP) may be suboptimal for some patients. We sought to determine whether antibiotic duration for VAP can be safely abbreviated in trauma patients using repeat bronchoalveolar lavage (BAL). Methods: This was an observational case-controlled pilot study. Fifty-two patients were treated for VAP using a repeat BAL clinical pathway. Definitive antibiotic therapy for VAP was discontinued if pathogen growth was <10,000 colony forming units/mL on repeat BAL performed on day 4 of antibiotic therapy (responder), otherwise therapy was continued per managing team. A matched control group of 52 VAP patients treated before (immediately consecutive) the pathway was used for comparison. Results: Antibiotic duration in pathway patients was shorter than control patients (9.8 days ± 3.8 days vs. 16.7 days ± 7.4 days; p < 0.001), including nonfermenting gram-negative bacilli VAP (10.7 days ± 4.1 days vs. 14.4 days ± 4.2 days; p < 0.001). There were no differences in pneumonia relapse, mechanical ventilator-free intensive care unit (ICU) days, ICU-free hospital days, or mortality. Of study group isolates, 86 (82.7{\%}) responded on repeat BAL and were treated for 8.8 days ± 3.3 days. Of these without concomitant infections (n = 65), antibiotic duration was 7.3 days ± 1.2 days compared with 14.4 days ± 2.6 days for nonresponding isolates (n = 18) (p < 0.001). Conclusions: Repeat BAL decreased the duration of antibiotic therapy for VAP in trauma patients. More adequately powered investigations are needed to appropriately determine the effects of this strategy on patient outcome.",
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AU - Chennault, Shanna K.

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