Comparison of 8 vs 15 Days of Antibiotics Therapy for Ventilator ...课件.ppt

Comparison of 8 vs 15 Days of Antibiotics Therapy for Ventilator-Associated Pneumonia in adultJAMA, November 19, 2003 Vol.290, No. 19 R2 曾政森 加護病房 July 2005 Introduction Hospitals and particularly ICUs and rapid dissemination of multiresistant bacteria. Nosocomial pneumonia in patients requiring ventilator represents one of the principle reasons for the prescription of antibiotics in ICU. The optimal duration of antibiotic Tx. for VAP ? Shortening the duration of antibiotics Tx. ? Patient’s prognosis ? Risk of relapse ? Objective To determine whether 8 days is as effective as 15 days of antibiotic treatment of patients with microbiologically proven VAP ! Study design and organization Randomized, double-blind trial on 2 parallel groups in 51 ICUs in France (May 1999 ~ June 2002) Inclusion criteria ICU patients, intubated and received ventilator 48hr Older than 18 y/o Clinical suspicion of VAP Positive quantitative cultures of distal pulmonary secretion samples, obtained by bronchoscope Instigation within 24hr following bronchoscope of appropriate empirical antibiotics Exclusion criteria Pregnancy Patients who were enrolled in other trial Little change of survival (SAPSII ≧ 65) Neutropenia (WBC 1000/μL or Neur. 500/μL) AIDS Receive immunosuppressants or long-term steroid therapy Concomitant extrapulmonary infection Randomization Patients were randomly assigned to receive antibiotics for 8 or 15 days 3 days after bronchoscope. The pathogens were well covered by initial empirical antibiotics. Computer-generated random-number table. Antibiotics treatment Drug selection was left to the discretion of the treating physicians. At least an aminoglycoside or a fluoroquinolone and a broad-spectrum betalactam antimicrobial agent Convert this initial regimen into a narrow spectrum therapy based on culture results Follow-up and definition BT, WBC, PaO2/FiO2, tracheal secretions, ventilator status, vital signs and ODIN score ? daily F/U SOFA and CXR on day 3,7,