Skip to main content
Top
Published in: Critical Care 1/2013

01-02-2013 | Commentary

A week seems to be weak: tailoring duration of antibiotic treatment in Gram-negative ventilator-associated pneumonia

Authors: Ignacio Martin-Loeches, Antoni Torres

Published in: Critical Care | Issue 1/2013

Login to get access

Abstract

The optimal length of antimicrobial therapy has not been extensively studied for a great majority of infections and, in critically ill patients affected by ventilator-associated pneumonia, is a persisting and unsolved issue confronting clinicians. The integration of biomarkers, clinical judgment, and microbiologic eradication might help to define a shorter duration for some ventilator-associated pneumonia episodes due to non-fermenting Gram-negative bacilli, but until these strategies are implemented in clinical practice for individualizing antibiotic treatment, a short-course duration does not seem to tailor a long benefit.
Literature
1.
go back to reference Kollef MH, Chastre J, Clavel M, Restrepo MI, Michiels B, Kaniga K, Cirillo I, Kimko H, Redman R: A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin for ventilator-associated pneumonia. Crit Care 2012, 16: R218. 10.1186/cc11862PubMedCentralCrossRefPubMed Kollef MH, Chastre J, Clavel M, Restrepo MI, Michiels B, Kaniga K, Cirillo I, Kimko H, Redman R: A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin for ventilator-associated pneumonia. Crit Care 2012, 16: R218. 10.1186/cc11862PubMedCentralCrossRefPubMed
2.
go back to reference Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754CrossRefPubMed Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302: 2323-2329. 10.1001/jama.2009.1754CrossRefPubMed
3.
go back to reference Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, Gibert C: Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respi Crit Care Med 1998, 157: 531-539.CrossRef Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, Gibert C: Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respi Crit Care Med 1998, 157: 531-539.CrossRef
4.
go back to reference Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH: Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001, 29: 1109-1115. 10.1097/00003246-200106000-00003CrossRefPubMed Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH: Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001, 29: 1109-1115. 10.1097/00003246-200106000-00003CrossRefPubMed
5.
go back to reference Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, Niederman M, Rello J, EU-VAP Study Investigators: Potentially-resistant microorganisms in intubated patients with hospital-acquired pneumonia. The interaction of ecology, shock and risk factors. Intensive Care Med, in press. Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, Niederman M, Rello J, EU-VAP Study Investigators: Potentially-resistant microorganisms in intubated patients with hospital-acquired pneumonia. The interaction of ecology, shock and risk factors. Intensive Care Med, in press.
6.
go back to reference Ferrer M, Liapikou A, Valencia M, Esperatti M, Theessen A, Antonio Martinez J, Mensa J, Torres A: Validation of the American Thoracic Society-Infectious Diseases Society of America guidelines for hospital-acquired pneumonia in the intensive care unit. Clin Infect Dis 2010, 50: 945-952. 10.1086/651075CrossRefPubMed Ferrer M, Liapikou A, Valencia M, Esperatti M, Theessen A, Antonio Martinez J, Mensa J, Torres A: Validation of the American Thoracic Society-Infectious Diseases Society of America guidelines for hospital-acquired pneumonia in the intensive care unit. Clin Infect Dis 2010, 50: 945-952. 10.1086/651075CrossRefPubMed
7.
go back to reference Micek ST, Ward S, Fraser VJ, Kollef MH: A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004, 125: 1791-1799. 10.1378/chest.125.5.1791CrossRefPubMed Micek ST, Ward S, Fraser VJ, Kollef MH: A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004, 125: 1791-1799. 10.1378/chest.125.5.1791CrossRefPubMed
8.
go back to reference Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S, Pneum A, Trial Group: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290: 2588-2598. 10.1001/jama.290.19.2588CrossRefPubMed Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S, Pneum A, Trial Group: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290: 2588-2598. 10.1001/jama.290.19.2588CrossRefPubMed
9.
go back to reference Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL: Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000, 162: 505-511.CrossRefPubMed Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL: Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000, 162: 505-511.CrossRefPubMed
10.
go back to reference 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: 388-416.CrossRef 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: 388-416.CrossRef
11.
go back to reference Póvoa P, Salluh JI: Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care 2012, 23: 32.CrossRef Póvoa P, Salluh JI: Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care 2012, 23: 32.CrossRef
12.
go back to reference Wunderink RG: Surrogate markers and microbiologic end points. Clin Infect Dis 2010,51(Suppl 1):S126-130.CrossRefPubMed Wunderink RG: Surrogate markers and microbiologic end points. Clin Infect Dis 2010,51(Suppl 1):S126-130.CrossRefPubMed
13.
go back to reference Montravers P, Fagon JY, Chastre J, Lecso M, Dombret MC, Trouillet JL, Gibert C: Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 1993, 147: 38-44. 10.1164/ajrccm/147.1.38CrossRefPubMed Montravers P, Fagon JY, Chastre J, Lecso M, Dombret MC, Trouillet JL, Gibert C: Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 1993, 147: 38-44. 10.1164/ajrccm/147.1.38CrossRefPubMed
14.
go back to reference Mueller EW, Croce MA, Boucher BA, Hanes SD, Wood GC, Swanson JM, Chennault SK, Fabian TC: Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. J Trauma 2007, 63: 1329-1337. 10.1097/TA.0b013e31812f6c46CrossRefPubMed Mueller EW, Croce MA, Boucher BA, Hanes SD, Wood GC, Swanson JM, Chennault SK, Fabian TC: Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. J Trauma 2007, 63: 1329-1337. 10.1097/TA.0b013e31812f6c46CrossRefPubMed
Metadata
Title
A week seems to be weak: tailoring duration of antibiotic treatment in Gram-negative ventilator-associated pneumonia
Authors
Ignacio Martin-Loeches
Antoni Torres
Publication date
01-02-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11899

Other articles of this Issue 1/2013

Critical Care 1/2013 Go to the issue