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Evaluating Short Versus Prolonged Course of Antibiotic Therapy in Adult Patients With Ventilator-Associated Pneumonia
Rachid Douglas-Louis1, John Cerenzio2, Justin Andrade2,3
1Department of Pharmacy, NYC Health + Hospitals/Kings County, Brooklyn, NY, USA.
Insights
Shortening antibiotic courses for ventilator-associated pneumonia (VAP) caused by specific bacteria may be safe. This study found similar mortality and recurrence rates for short versus prolonged antibiotic durations in VAP patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Current guidelines recommend 7-day antibiotic courses for hospital-acquired and ventilator-associated pneumonia (VAP).
- Recent evidence questions the necessity of prolonged antibiotic therapy, especially for VAP caused by *Pseudomonas aeruginosa*.
- Optimal antibiotic duration for VAP due to non-lactose-fermenting gram-negative bacilli (NF-GNB) remains unclear.
Purpose of the Study:
- To evaluate the impact of antibiotic therapy duration on clinical outcomes in patients with VAP caused by NF-GNB.
- To compare 30-day mortality, pneumonia recurrence, and length of stay between short (<10 days) and prolonged (≥10 days) antibiotic treatment groups.
- To inform evidence-based treatment strategies for VAP caused by challenging pathogens.
Main Methods:
- Retrospective cohort study at a community teaching hospital.
- Inclusion criteria: hospitalized patients with VAP caused by NF-GNB between September 2015 and December 2023.
- Comparison of outcomes between patients receiving short-duration versus prolonged-duration antibiotic therapy.
Main Results:
- No significant difference in 30-day mortality between short (17%) and prolonged (21%) antibiotic groups (P = .50).
- Pneumonia recurrence rates were also comparable: 26% for short duration vs. 18% for prolonged duration (P = .22).
- Patients receiving prolonged antibiotic therapy had a significantly longer hospital stay (35 days vs. 25 days; P = .01).
Conclusions:
- Short-duration antibiotic therapy appears non-inferior to prolonged therapy for VAP caused by NF-GNB in terms of mortality and recurrence.
- Prolonged antibiotic courses may be associated with increased hospital length of stay.
- Further prospective research is warranted to confirm optimal antibiotic duration for this patient population.
Abstract:
Although the 2016 American Thoracic Society/Infectious Diseases of America (ATS/IDSA) guidelines recommend a 7-day antibiotic course for hospital-acquired and ventilator-associated pneumonia (VAP), recent trials have challenged this recommendation, particularly for VAP caused by P. aeruginosa. The objective of this study is to provide insights into the optimal duration of antibiotic therapy for VAP caused by non-lactose-fermenting gram-negative bacilli (NF-GNB). This project is a single-center, retrospective cohort study at a community teaching hospital. Patients were included if they were hospitalized with VAP caused by NF-GNB between September 6, 2015 and December 22, 2023. Patients were divided into two groups: those receiving prolonged duration of antibiotic therapy (greater than or equal to 10 days) and those receiving short duration of antibiotic therapy (less than 10 days). The primary endpoint is 30-day mortality from the first day of pathogen-directed therapy. Secondary endpoints include pneumonia recurrence within 30 days, intensive care unit and overall hospital length of stay. The three most prevalent pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia respectively. Both 30-day mortality and recurrence were comparable between groups (17% vs 21%; P = .50) and (26% vs 18%; P = .22) respectively. Patients in the prolonged duration group had a higher hospital length of stay with 35 days as compared to 25 days in the short duration group; P = .01. Thirty-day mortality and pneumonia recurrence rates were similar comparing short vs prolonged antibiotic duration in VAP caused by NF-GNB. Further prospective studies are needed to address the optimal duration of therapy in this group of patients.
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