Delayed Antibiotic Therapy in Non-severe Ventilator Acquired Pneumonia (VAP)

Completed

• Conditions: Ventilator Associated Pneumonia; Critical Care; Antibiotic Therapy
• Interventions: Other: Restrictive antibiotic strategy; Other: Aggressive antibiotic strategy

• Registration Number: NCT05205525
• Lead Sponsor: Nantes University Hospital

Brief Summary

This retro-prospective monocentric observational study compare the impact of the implementation of a restrictive (delayed) versus aggressive (immediate) antibiotic strategy for Ventilator Acquired Pneumonia suspicion without severity symptoms.

Detailed Description

Ventilator acquired pneumonia (VAP) is the leading cause of nosocomial infection in intensive care patients, and has been associated with increased antibiotic consumption, increased morbidity and mortality. VAP diagnosis is difficult due to subjective or non-specific criteria. Delaying antibiotic treatment for VAP suspicion without severity symptoms raises question since the probability of VAP diagnosis, as well as the risk of delaying treatment, is very uncertain. It may nonetheless limit the environmental impact of antibiotic use which is a public health concern. We compared antibiotic sparing and patient outcome, before and after the implementation of a restrictive (delayed) antibiotic strategy versus an aggressive (immediate) antibiotic strategy in VAP suspicion without severity symptoms.

Study Timeline

• Study Start: 2022-01-06
• Study First Submitted: 2022-01-11
• Study First Submitted QC: 2022-01-11
• Study First Posted: 2022-01-25
• Primary Completion: 2023-01-28
• Study Completion: 2023-01-28
• Status Verified: 2023-03
• Last Update Submitted: 2023-03-07
• Last Update Posted: 2023-03-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 87

Inclusion Criteria

• Under mechanical ventilation from more than 48 hours
• Suspected for a ventilator acquired pneumonia, requiring a distal pulmonary bacterial sample

Exclusion Criteria

• New or worsening shock requiring vasopressor
• New or worsening severe hypoxemia (PaO2/FiO2<150 in FiO2≥60% and peep 10)
• Patient under veno-veinous extracorporeal membrane oxygenation
• Neutropenia <1G/L or immunosuppressive treatment (including corticosteroids >6 months or >0.5mg/kg/j)
• Disease (endocarditis, spondylodyscitis, deep abcedation...) requiring prolonged antibiotic therapy

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Restrictive antibiotic strategy	Restrictive antibiotic strategy	-
Aggressive (immediate) antibiotic strategy	Aggressive antibiotic strategy	-

Primary Outcome Measures

Name	Time	Method
antibiotic-free days	28 days	antibiotic-free days until Day 28 of Intensive Care Units stay

Secondary Outcome Measures

Name	Time	Method
Mechanical ventilation free days	28 days	Mechanical ventilation free days during the first 28 days
Intensive care unit stay length	28 days
Intensive care unit mortality	28 days
Hospitality mortality	28 days

Trial Locations

Locations (1)

University Nantes Hospital; 🇫🇷 Nantes, France