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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