Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. We assessed differences in the bacterial etiology of early-onset versus late-onset VAP.
METHODS: Subjects enrolled in 2004–2006 in 2 clinical studies of doripenem versus imipenem or piperacillin/tazobactam, with a diagnosis of VAP (n = 500) were included in the analysis. Subjects were classified by ventilator status: early-onset VAP (< 5 d of ventilation) or late-onset VAP (≥ 5 d of ventilation). Baseline demographics and bacterial etiology were analyzed by VAP status.
RESULTS: Late-onset VAP subjects had higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (mean 16.6 versus 15.5, P = .008). There were no significant differences in Clinical Pulmonary Infection Score, sex, age, or presence of bacteremia between the groups. A total of 496 subjects had a baseline pathogen, and 50% of subjects in each group had ≥ 2 pathogens. With the exception of Staphylococcus aureus, which was common in early-onset VAP, the pathogens (including potentially multidrug-resistant (MDR) pathogens) isolated from early-onset versus late-onset VAP were not significantly different between groups. Acinetobacter baumannii or Pseudomonas aeruginosa with decreased susceptibility to any study drug was observed in early-onset and late-onset VAP subjects.
CONCLUSIONS: There were no significant differences in the prevalence of potential MDR pathogens associated with early-onset or late-onset VAP, even in subjects with prior antibiotics. Empiric therapy for early-onset VAP should also include agents likely to be effective for potential MDR pathogens. Further prospective studies should evaluate microbiology trends in subjects with VAP.
- ventilator-associated pneumonia
- ICU
- outcome and process assessment
- critical care
- microbiology
- early onset
- late onset
- mechanical ventilation
Footnotes
- Correspondence: Marcos I Restrepo MD MSc; Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), 11C6, South Texas Veterans Health Care System, ALMD-7400 Merton Minter Boulevard, San Antonio TX 78229. E-mail: restrepom{at}uthscsa.edu.
Dr Restrepo was partly supported by grant K23HL096054 from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; the Department of Veterans Affairs; nor the University of Texas Health Science Center at San Antonio.
Dr Restrepo has disclosed relationships with Ortho-McNeil-Janssen, Theravance, Forest Laboratories, Johnson & Johnson, Trius, Novartis, and Wyeth/Pfizer. The other authors have disclosed no conflicts of interest.
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