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Open Access 01-06-2008 | Research

Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study

Authors: Saad Nseir, Raphaël Favory, Elsa Jozefowicz, Franck Decamps, Florent Dewavrin, Guillaume Brunin, Christophe Di Pompeo, Daniel Mathieu, Alain Durocher, the VAT Study Group

Published in: Critical Care | Issue 3/2008

Abstract

Introduction

Ventilator-associated tracheobronchitis (VAT) is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated with reduced duration of mechanical ventilation.

Methods

We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.

Results

Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median [interquartile range], 12 [8 to 24] versus 2 [0 to 6] days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.

Conclusion

In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.

Trial registration

ClinicalTrials.gov, number NCT00122057.

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Title: Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study
Authors: Saad Nseir
Raphaël Favory
Elsa Jozefowicz
Franck Decamps
Florent Dewavrin
Guillaume Brunin
Christophe Di Pompeo
Daniel Mathieu
Alain Durocher
the VAT Study Group
Publication date: 01-06-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6890

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study

Abstract

Introduction

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Trial registration

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