Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia

Abstract

Objectives: Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP.

Design and setting: Retrospective analysis of prospectively collected data in a medical-surgical intensive care unit (ICU) of a university hospital.

Patients and methods: We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA-BAL (concordant group), discordant EA-BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups.

Measurements and main results: Ninety assessable EA-BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P < 0.05) to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate. No significant difference was observed between the three groups for length of mechanical ventilation, length of ICU stay, nonpulmonary nosocomial infections and mortality.

Conclusion: Once-a-week routine quantitative EA cultures may help to improve the adequacy of empiric antibiotic therapy for VAP.