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A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated
Scott T Micek1, Suzanne Ward, Victoria J Fraser
1Department of Pharmacy, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA.
Objective:
To evaluate an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia (VAP).
Design:
Prospective, randomized, controlled clinical trial.
Setting:
A medical ICU from a university-affiliated urban teaching hospital.
Patients:
Between April 2002 and July 2003, 290 patients completed the clinical trial.
Interventions:
Patients were assigned to have the duration of antibiotic treatment for VAP determined by an antibiotic discontinuation policy (discontinuation group) or their treating physician teams (conventional group).
Results:
Severity of illness using APACHE (acute physiology and chronic health evaluation) II score (22.8 +/- 9.0 vs 23.2 +/- 9.4, p = 0.683) [mean +/- SD] and the clinical pulmonary infection score (7.1 +/- 0.9 vs 7.2 +/- 0.9, p = 0.222) were similar for both patient groups. The duration of antibiotic treatment for VAP was statistically shorter among patients in the discontinuation group compared to patients in the conventional antibiotic management group (6.0 +/- 4.9 days vs 8.0 +/- 5.6 days, p = 0.001). The occurrence of a secondary episode of VAP was not statistically different between these two groups (17.3% vs 19.3%, p = 0.667). Hospital mortality (32.0% vs 37.1%, p = 0.357) and ICU length of stay (6.8 +/- 6.1 days vs 7.0 +/- 7.3 days, p = 0.798) were also statistically similar.
Conclusions:
The application of an antibiotic discontinuation policy for clinically suspected VAP was associated with a decrease in the overall duration of antibiotic treatment. These findings suggest that shorter courses of empiric antibiotic therapy for patients treated for clinically suspected VAP can be safely achieved.
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