Abstract
Purpose: To assess potential differences in bacterial etiology of subjects with early-onset vs. late-onset ventilator associated pneumonia (VAP).
Methods: Subjects enrolled in 2004-2006 in 2 clinical studies of doripenem vs. 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 days of ventilation) or late-onset VAP (≥5 days of ventilation)]. Baseline demographics and bacterial etiology were analyzed by VAP status.
Results: Late-onset VAP subjects had higher APACHE II scores [mean 16.6 vs. 15.5 (p=0.008)]. There were no significant differences in CPIS, gender, age, or presence of bacteremia between 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, pathogens, including potentially MDR, isolated from early vs. late-onset VAP was not significantly different between groups. Acinetobacter baumannii or Pseudomonas aeruginosa with decreased susceptibility to any study drug was observed in early and late onset VAP subjects.
Conclusion: There were no significant differences in the prevalence of potential MDR pathogens associated with early or late-onset VAP, even in subjects with prior antibiotics.
Clinical Implications: VAP is classified as early-onset or late-onset, in part, to identify subjects at risk for infection with resistant pathogens. 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
- Intensive care unit
- Outcome and process assessment
- Critical care
- Microbiology
- Early onset
- Late onset
- Mechanical ventilation
Footnotes
- Corresponding author: Marcos I. Restrepo, MD, MSc; VERDICT (11C6) — South Texas Veterans Health Care System ALMD – 7400 Merton Minter Boulevard – San Antonio Texas, 78229; Phone: (210)-617-5300 ext. 15413 – Fax: (210) 567-4423; Email: restrepom{at}uthscsa.edu
Dr. Marcos I. Restrepo participated in advisory boards for Ortho-McNeil-Janssen, Theravance, Forest Laboratories, Johnson & Johnson, Trius and Novartis. Consultant for Theravance, Trius and Pfizer (Wyeth). No conflicts of interest were reported by Drs. Juan F. Fernandez
Support: Dr. Restrepo time is partially protected by Award Number K23HL096054 from the National Heart, Lung, And Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, And Blood Institute or the National Institutes of Health.”
The funding agencies had no role in the preparation, review, or approval of the manuscript. The views expressed in this article are those of the author and do not necessarily represent the views of the Department of Veterans Affairs, nor the University of Texas Health Science Center at San Antonio.
- Copyright © 2013 by Daedalus Enterprises Inc.