Delayed Antibiotic Therapy in Non-severe Ventilator Acquired Pneumonia (VAP)

Study Overview
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Brief Summary
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This retro-prospective monocentric observational study compare the impact of the implementation of a restrictive (delayed) versus aggressive (immediate) antibiotic strategy for Ventilator Acquired Pneumonia suspicion without severity symptoms.

Detailed Description
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Ventilator acquired pneumonia (VAP) is the leading cause of nosocomial infection in intensive care patients, and has been associated with increased antibiotic consumption, increased morbidity and mortality. VAP diagnosis is difficult due to subjective or non-specific criteria. Delaying antibiotic treatment for VAP suspicion without severity symptoms raises question since the probability of VAP diagnosis, as well as the risk of delaying treatment, is very uncertain. It may nonetheless limit the environmental impact of antibiotic use which is a public health concern. We compared antibiotic sparing and patient outcome, before and after the implementation of a restrictive (delayed) antibiotic strategy versus an aggressive (immediate) antibiotic strategy in VAP suspicion without severity symptoms.

Official Title
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Aggressive Versus Restrictive Initiation of Antimicrobial Treatment in Critically Ill Patients With Suspected Ventilator Acquired Pneumonia Without Severity : a Before and After Observational Study

Conditions
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Ventilator Associated Pneumonia, Critical Care, Antibiotic Therapy

Intervention / Treatment
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* Other: Restrictive antibiotic strategy
* Other: Aggressive antibiotic strategy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Under mechanical ventilation from more than 48 hours Suspected for a ventilator acquired pneumonia, requiring a distal pulmonary bacterial sample Exclusion Criteria: New or worsening shock requiring vasopressor New or worsening severe hypoxemia (PaO2/FiO2<150 in FiO2≥60% and peep 10) Patient under veno-veinous extracorporeal membrane oxygenation Neutropenia <1G/L or immunosuppressive treatment (including corticosteroids >6 months or >0.5mg/kg/j) Disease (endocarditis, spondylodyscitis, deep abcedation…) requiring prolonged antibiotic therapy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Restrictive antibiotic strategy<br> | Other: Restrictive antibiotic strategy<br>* Implementation of a restrictive (delayed) antibiotic strategy in Ventilator Acquired Pneumonia suspicion without severity symptoms.<br>|
| Aggressive (immediate) antibiotic strategy<br> | Other: Aggressive antibiotic strategy<br>* Implementation of an aggressive (immediate) antibiotic strategy in Ventilator Acquired Pneumonia suspicion without severity symptoms.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| antibiotic-free days | antibiotic-free days until Day 28 of Intensive Care Units stay | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical ventilation free days | Mechanical ventilation free days during the first 28 days | 28 days | 
| Intensive care unit stay length |  | 28 days | 
| Intensive care unit mortality |  | 28 days | 
| Hospitality mortality |  | 28 days |