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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

From starting mechanical ventilation to ventilator-associated pneumonia, choosing the right moment to start antibiotic treatment

Authors: Paula Ramirez, Cristina Lopez-Ferraz, Monica Gordon, Alexandra Gimeno, Esther Villarreal, Jesús Ruiz, Rosario Menendez, Antoni Torres

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Ventilator-associated pneumonia (VAP) can have a clear onset or may be a result of the gradual appearance of symptoms and signs of VAP (gradual VAP). The aim of this paper is to describe the VAP development process with the intention of discriminating between those pneumonias with a clear beginning and those that are diagnosed after a period of maturation. In addition, we evaluate the effect of the starting time of antibiotic treatment in both situations.

Methods

Consecutive ventilated patients fulfilling VAP criteria were included. The patients were monitored for clinical, microbiological, and inflammatory signs. Patients with VAP were classified into two groups: (1) nongradual VAP (patients in whom all VAP criteria were detected for the first time on the day of diagnosis) and (2) gradual VAP (progressive appearance of signs and symptoms throughout the pre-VAP period [<96 h to >24 h before VAP diagnosis]).

Results

A total of 71 patients with VAP were identified, of whom 43 (61 %) had gradual VAP, most of whom (n = 38, 88 %) had late-onset VAP. Antibiotic treatment was given to 34 (79 %) patients with gradual VAP in the pre-VAP period, and empirical antibiotic treatment was appropriate in 22 patients (51 %). The patients with an appropriate empirical treatment had a higher percentage of early clinical response to treatment (68 % [n = 15] vs. 28 % [n = 7]; p = 0.009). An attempt was made to find a diagnostic test capable of identifying the infectious process underway, but clinical scales and biomarkers of inflammation helped us to achieve acceptable results.

Conclusions

Gradual emergence of VAP, mainly of late onset, is a common condition. Clinicians should be aware of this gradual onset of the infection to establish an early antibiotic treatment, even before the classic diagnostic criteria for VAP are applied.
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Metadata
Title
From starting mechanical ventilation to ventilator-associated pneumonia, choosing the right moment to start antibiotic treatment
Authors
Paula Ramirez
Cristina Lopez-Ferraz
Monica Gordon
Alexandra Gimeno
Esther Villarreal
Jesús Ruiz
Rosario Menendez
Antoni Torres
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1342-1

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