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Intensive Care Medicine

, Volume 39, Issue 9, pp 1547–1555 | Cite as

Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients

  • Emilio Bouza
  • María Jesús Pérez GrandaEmail author
  • Javier Hortal
  • José M. Barrio
  • Emilia Cercenado
  • Patricia Muñoz
Original

Abstract

Purpose

Patients requiring mechanical ventilation (MV) for >48 h after major heart surgery (MHS) are at a high risk of acquiring ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented. The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population.

Methods

We performed a prospective randomized open-label study of MHS patients requiring MV for >48 h. Patients were randomly allocated to one of two groups: the intervention group, which received a 3-day course of linezolid and meropenem, and the control group, which received the standard of care. The main outcome was the development of VAP or VAT.

Results

Overall, of the 78 patients included in the study, 40 were in the intervention group and 38 in the control group. Both groups were comparable. Data for the intervention and control groups respectively were as follows: VAP + VAT/1,000 days was 31.79 vs 64.78 (p = 0.03), median length of MV before the first episode of VAP or VAT 9 vs 4.5 days (p = 0.02). No significant differences were observed in median length of stay in the intensive care unit, median length of hospital stay, antibiotic use, Clostridium difficile infection, and overall mortality rate. We detected linezolid-resistant coagulase-negative and coagulase-positive staphylococci in the MHS intensive care unit after the study period.

Conclusions

A pre-emptive approach with broad-spectrum antibiotics may be effective in reducing the incidence and delaying the onset of VAP + VAT after MHS. The ecological consequences have to be carefully evaluated in future trials.

Keywords

Ventilator-associated pneumonia Prevention Major heart surgery Pre-emptive treatment Intensive care Linezolid Meropenem 

Abbreviations

ASA

American Society of Anesthesiologists

CASS

Continuous aspiration of subglottic secretions

CDI

Clostridium difficile infection

CDC

Centers for Disease Control and Prevention

DDDs

Daily defined doses

EuroSCORE

European System for Cardiac Operative Risk Evaluation

EA

Endotracheal aspirates

ICU

Intensive care unit

IQR

Interquartile range

LRTI

Lower respiratory tract infections

MHS

Major heart surgery

MV

Mechanical ventilation

NYH

New York Heart Association

SD

Standard deviation

VAP

Ventilator-associated pneumonia

VAT

Ventilator-associated tracheobronchitis

Notes

Acknowledgments

We thank Thomas O’Boyle for his help in the preparation of the English version of the manuscript and Cristina Fernández for the statistical analysis. Supported in part by Ciber de Enfermedades Respiratorias (CIBERES) and by the Rafael del Pino Foundation. This study was partially supported by grants from the Fondo de Investigación Sanitaria FIS PI070896, FIS PIO9/1257, and FISPI10/02869 (Instituto de Salud Carlos III).

Conflicts of interest

None of the authors have any conflicts of interest to declare.

Supplementary material

134_2013_2997_MOESM1_ESM.doc (124 kb)
Supplementary material 1 (DOC 125 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Emilio Bouza
    • 1
    • 2
    • 4
    • 5
    • 6
  • María Jesús Pérez Granda
    • 2
    • 3
    Email author
  • Javier Hortal
    • 2
    • 3
  • José M. Barrio
    • 2
    • 3
  • Emilia Cercenado
    • 1
    • 2
    • 4
    • 5
    • 6
  • Patricia Muñoz
    • 1
    • 2
    • 4
    • 5
    • 6
  1. 1.Department of Clinical Microbiology and Infectious DiseasesHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Ciber de Enfermedades Respiratorias (CIBERES)MadridSpain
  3. 3.Department of AnesthesiologyHospital General Universitario Gregorio MarañónMadridSpain
  4. 4.Department of MedicineUniversidad ComplutenseMadridSpain
  5. 5.Red Española de Investigación en Patología Infecciosa (REIPI)MadridSpain
  6. 6.Servicio de Microbiología Clínica y Enfermedades InfecciosasHospital General Universitario Gregorio MarañónMadridSpain

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