Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury. Issue 4 (7th January 2016)

• Record Type: Journal Article
• Authors: Roquilly, Antoine; Feuillet, Fanny; Seguin, Philippe; Lasocki, Sigismond; Cinotti, Raphael; Launey, Yoann; Thioliere, Lise; Le Floch, Ronan; Mahe, Pierre Joachim; Nesseler, Nicolas; Cazaubiel, Tanguy; Rozec, Bertrand; Lepelletier, Didier; Sebille, Véronique; Malledant, Yannick; Asehnoune, Karim
• Is Part Of: European respiratory journal. Volume 47:Issue 4(2016)
• Page Start: 1219
• Page End: 1228
• Publication Date: 2016-01-07
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01314-2015
• Languages: English
• ISSNs: 0903-1936

Abstract

Issues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations. To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients. The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (p<0.001) and VAP onset ≥10 days (p<0.001); the area under the receiver operating characteristic curve (AUC) was 0.822 (95% CI 0.770–0.883) in the learning cohort and 0.805 (95% CI 0.732–0.877) in the validation cohort. The score built from the factors selected in multivariate analysis predicted resistance with a sensitivity of 83%, a specificity of 71%, a positive predictive value of 37% and a negative predictive value of 96% in the validation cohort. The AUC of the multivariate analysis was poor in burn patients (0.671, 95% CI 0.596–0.751). Limited-spectrum empirical antimicrobial therapy has low risk of failure in brain-injured patients presenting with VAP before day 10 and when prior antimicrobial therapy lasts <48 h. To stop spread of resistant bacteria, we should limit broad antimicrobial therapy in brain-injured pneumonia patients http://ow.ly/UL3pS