Aggressive Versus Restrictive Initiation of Antimicrobial Treatment in Critically Ill Patients With Suspected Ventilator Acquired Pneumonia Without Severity : a Before and After Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 87
- 试验地点
- 1
- 主要终点
- antibiotic-free days
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Under mechanical ventilation from more than 48 hours
- •Suspected for a ventilator acquired pneumonia, requiring a distal pulmonary bacterial sample
排除标准
- •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
结局指标
主要结局
antibiotic-free days
时间窗: 28 days
antibiotic-free days until Day 28 of Intensive Care Units stay
次要结局
- Mechanical ventilation free days(28 days)
- Intensive care unit stay length(28 days)
- Intensive care unit mortality(28 days)
- Hospitality mortality(28 days)