Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia. Leroy, O., Meybeck, A., d'Escrivan , T., Devos, P., Kipnis, E., & Georges, H. Intensive care medicine, 29(12):2170–2173, December, 2003. doi abstract bibtex OBJECTIVE: To study the prognostic impact of the appropriateness of initial antimicrobial therapy in patients suffering from ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Observational cohort from January 1994 to December 2001 in one intensive care unit (ICU) from an university-affiliated, urban teaching hospital. PATIENTS: All 132 consecutive patients exhibiting bacteriologically documented VAP during ICU stay. MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40% vs. 62%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.
@article{leroy_impact_2003,
title = {Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia.},
volume = {29},
issn = {0342-4642 0342-4642},
doi = {10.1007/s00134-003-1990-x},
abstract = {OBJECTIVE: To study the prognostic impact of the appropriateness of initial antimicrobial therapy in patients suffering from ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Observational cohort from January 1994 to December 2001 in one intensive care unit (ICU) from an university-affiliated, urban teaching hospital. PATIENTS: All 132 consecutive patients exhibiting bacteriologically documented VAP during ICU stay. MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40\% vs. 62\%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.},
language = {eng},
number = {12},
journal = {Intensive care medicine},
author = {Leroy, Olivier and Meybeck, Agnes and d'Escrivan, Thibaud and Devos, Patrick and Kipnis, Eric and Georges, Hugues},
month = dec,
year = {2003},
pmid = {13680112},
keywords = {Humans, Anti-Bacterial Agents/*therapeutic use, Female, Aged, Intensive Care Units, Male, Middle Aged, Prognosis, Cohort Studies, Drug Therapy, Combination, Pneumonia/*drug therapy/etiology/mortality, Respiration, Artificial/*adverse effects},
pages = {2170--2173}
}
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MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40% vs. 62%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.","language":"eng","number":"12","journal":"Intensive care medicine","author":[{"propositions":[],"lastnames":["Leroy"],"firstnames":["Olivier"],"suffixes":[]},{"propositions":[],"lastnames":["Meybeck"],"firstnames":["Agnes"],"suffixes":[]},{"propositions":["d'Escrivan"],"lastnames":[],"firstnames":["Thibaud"],"suffixes":[]},{"propositions":[],"lastnames":["Devos"],"firstnames":["Patrick"],"suffixes":[]},{"propositions":[],"lastnames":["Kipnis"],"firstnames":["Eric"],"suffixes":[]},{"propositions":[],"lastnames":["Georges"],"firstnames":["Hugues"],"suffixes":[]}],"month":"December","year":"2003","pmid":"13680112","keywords":"Humans, Anti-Bacterial Agents/*therapeutic use, Female, Aged, Intensive Care Units, Male, Middle Aged, Prognosis, Cohort Studies, Drug Therapy, Combination, Pneumonia/*drug therapy/etiology/mortality, Respiration, Artificial/*adverse effects","pages":"2170–2173","bibtex":"@article{leroy_impact_2003,\n\ttitle = {Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia.},\n\tvolume = {29},\n\tissn = {0342-4642 0342-4642},\n\tdoi = {10.1007/s00134-003-1990-x},\n\tabstract = {OBJECTIVE: To study the prognostic impact of the appropriateness of initial antimicrobial therapy in patients suffering from ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Observational cohort from January 1994 to December 2001 in one intensive care unit (ICU) from an university-affiliated, urban teaching hospital. PATIENTS: All 132 consecutive patients exhibiting bacteriologically documented VAP during ICU stay. MEASUREMENTS AND RESULTS: Initial antimicrobial treatment was deemed appropriate when the period from initial VAP diagnosis and subsequent administration of antibiotics was within 24 h and all causative pathogens were in vitro susceptible to at least one of the antibiotics of the regimen. Such a treatment was present in 106 episodes. Fifty-eight patients died. In bivariate analysis an appropriate initial antimicrobial therapy was associated with a significantly lower mortality rate (40\\% vs. 62\\%). In multivariate analysis the three independent factors present upon VAP onset and associated with death were pulmonary involvement of more than a single lobe on chest radiograph, platelet count less than 150000/mm(3), and Simplified Acute Physiology Score II higher than 37. Appropriate antimicrobial therapy was associated with a nonsignificant trend toward a lower mortality. CONCLUSIONS: In our cohort the mortality rate was lower in patients suffering from VAP when the initial antimicrobial therapy was appropriate. However, such a factor did not appear as an independent prognostic factor.},\n\tlanguage = {eng},\n\tnumber = {12},\n\tjournal = {Intensive care medicine},\n\tauthor = {Leroy, Olivier and Meybeck, Agnes and d'Escrivan, Thibaud and Devos, Patrick and Kipnis, Eric and Georges, Hugues},\n\tmonth = dec,\n\tyear = {2003},\n\tpmid = {13680112},\n\tkeywords = {Humans, Anti-Bacterial Agents/*therapeutic use, Female, Aged, Intensive Care Units, Male, Middle Aged, Prognosis, Cohort Studies, Drug Therapy, Combination, Pneumonia/*drug therapy/etiology/mortality, Respiration, Artificial/*adverse effects},\n\tpages = {2170--2173}\n}\n\n","author_short":["Leroy, O.","Meybeck, A.","d'Escrivan , T.","Devos, P.","Kipnis, E.","Georges, H."],"key":"leroy_impact_2003","id":"leroy_impact_2003","bibbaseid":"leroy-meybeck-descrivan-devos-kipnis-georges-impactofadequacyofinitialantimicrobialtherapyontheprognosisofpatientswithventilatorassociatedpneumonia-2003","role":"author","urls":{},"keyword":["Humans","Anti-Bacterial Agents/*therapeutic use","Female","Aged","Intensive Care Units","Male","Middle Aged","Prognosis","Cohort Studies","Drug Therapy","Combination","Pneumonia/*drug therapy/etiology/mortality","Respiration","Artificial/*adverse effects"],"metadata":{"authorlinks":{}}},"bibtype":"article","biburl":"https://pro.univ-lille.fr/fileadmin/user_upload/pages_pros/patrick_devos/zotero.bib","dataSources":["RjzxJmiLeBgJeLTkb"],"keywords":["humans","anti-bacterial agents/*therapeutic use","female","aged","intensive care units","male","middle aged","prognosis","cohort studies","drug therapy","combination","pneumonia/*drug therapy/etiology/mortality","respiration","artificial/*adverse effects"],"search_terms":["impact","adequacy","initial","antimicrobial","therapy","prognosis","patients","ventilator","associated","pneumonia","leroy","meybeck","d'escrivan ","devos","kipnis","georges"],"title":"Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia.","year":2003}