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Defining Pathogen and Susceptibility Patterns for Early Versus Late Ventilator Associated Pneumonia in Trauma

Kaitlin M Alexander1, S Noelle Davis2, C Caleb Butts2

  • 1College of Pharmacy, University of Florida, Gainesville, FL, USA.

The American Surgeon
|August 18, 2022
PubMed
Abstract

Insights

Routine broad-spectrum antibiotics may not be necessary for early ventilator-associated pneumonia (VAP) in trauma patients. However, ampicillin/sulbactam or ceftriaxone monotherapy lacked reliable coverage for early VAP in this study.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Trauma Surgery

Background:

  • Early-onset ventilator-associated pneumonia (VAP) in trauma patients (< 7 days) is associated with a lower risk of specific resistant infections.
  • Current practices often involve broad-spectrum antibiotics for early VAP, but their necessity is questioned.

Purpose of the Study:

  • To evaluate the necessity of routine broad-spectrum antibiotics for trauma patients diagnosed with early-VAP.
  • To compare the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in early- versus late-VAP.
  • To assess the susceptibility of common pathogens to specific antibiotics in early-VAP.

Main Methods:

  • Retrospective cohort study of adult trauma patients with VAP.
  • Primary outcome: presence of MRSA and/or P. aeruginosa in early- and late-VAP.
  • Secondary outcomes: bacterial susceptibility, ICU/hospital length of stay, ventilator-free days, and mortality.

Main Results:

  • 164 patients included; 208 organisms identified (90 early VAP, 118 late VAP).
  • MRSA incidence: 7.7% (early VAP), P. aeruginosa incidence: 5.6% (early VAP).
  • Susceptibility to ampicillin/sulbactam: 73.3% (early VAP); ceftriaxone: 83.3% (early VAP). Late VAP had longer ICU stay (P=0.040), early VAP had higher mortality (P=0.012).

Conclusions:

  • Monotherapy with ampicillin/sulbactam or ceftriaxone did not provide reliable broad-spectrum coverage for early-VAP in this cohort.
  • Institutional analysis is crucial to ensure appropriate initial treatment for VAP.
  • Findings suggest a need to re-evaluate antibiotic strategies for early VAP in trauma patients.
Keywords:
ICUcritical carelungspharmacysurgical infection

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