Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008;12(3):R62.
doi: 10.1186/cc6890. Epub 2008 May 2.

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

Saad Nseir  1 , Raphaël Favory, Elsa Jozefowicz, Franck Decamps, Florent Dewavrin, Guillaume Brunin, Christophe Di Pompeo, Daniel Mathieu, Alain Durocher; VAT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Saad Nseir et al. Crit Care. 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Profile of modified intention-to-treat analysis. DNR, do not resuscitate.
Figure 2
Figure 2
Number of patients randomly assigned to the antibiotic group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Five patients had polymicrobial ventilator-associated tracheobronchitis (VAT).
Figure 3
Figure 3
Number of patients randomly assigned to the control group with different concentrations of microorganisms in the endotracheal aspirate at different time points. Two patients had polymicrobial ventilator-associated tracheobronchitis (VAT).
Figure 4
Figure 4
Kaplan-Meier survival curves for patients randomly assigned to the antibiotic and control groups. The dashed line represents the cumulative survival for patients randomly assigned to the antibiotic group, the solid line represents the cumulative survival for patients randomly assigned to the no antibiotic group, and + represents censored patients. P = 0.047 by the log rank test. ICU, intensive care unit.
See this image and copyright information in PMC

Comment in

References

    1. Nseir S, Di Pompeo C, Pronnier P, Beague S, Onimus T, Saulnier F, Grandbastien B, Mathieu D, Delvallez-Roussel M, Durocher A. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur Respir J. 2002;20:1483–1489. doi: 10.1183/09031936.02.00012902. - DOI - PubMed
    1. Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, Torres A. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med. 2007;35:1543–1549. doi: 10.1097/01.CCM.0000266686.95843.7D. - DOI - PubMed
    1. Bouza E, Pérez A, Muñoz P, Jesús Pérez M, Rincón C, Sánchez C, Martín-Rabadán P, Riesgo M, Cardiovascular Infection Study Group Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med. 2003;31:1964–1970. doi: 10.1097/01.ccm.0000084807.15352.93. - DOI - PubMed
    1. Nseir S, Di Pompeo C, Soubrier S, Delour P, Onimus T, Saulnier F, Durocher A. Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: a case-control study. Infection. 2004;32:210–216. doi: 10.1007/s15010-004-3167-0. - DOI - PubMed
    1. Nseir S, Di Pompeo C, Soubrier S, Lenci H, Delour P, Onimus T, Saulnier F, Mathieu D, Durocher A. Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure: a case-control study. Crit Care. 2005;9:R238–R245. doi: 10.1186/cc3508. - DOI - PMC - PubMed

Publication types

MeSH terms

Associated data