| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
1 From the Department of Medicine, Keesler Medical Center, Keesler AFB, Miss.
2 From the Clinical Research Laboratory, Keesler Medical Center, Keesler AFB, Miss.
3 From the Division of Pulmonary and Critical Care Medicine, University of South Alabma College of Medicine, Mobile
Study objective: To determine the impact of antibiotic treatment of ventilator-associated pneumonia (VAP) on survival.
Design: Decision analysis.
Patients: A hypothetical cohort of immunocompetent patients receiving mechanical ventilation who have suspected bacterial pneumonia. The analysis was performed separately for the following diagnostic techniques: clinical criteria, bronchoscopic protected specimen brush (PSB), and nonbronchoscopic protected BAL (pBAL). Additional factors accounted for in the analysis included the presence or absence of prior antibiotic use, mortality of antibiotic-treated and untreated pneumonia, mortality attributable to VAP, development of antibiotic resistance, and mortality due to adverse drug reactions.
Measurements and results: The overall survival of patients who receive antibiotic therapy was compared to survival if antibiotic therapy had been withheld. Antibiotic treatment of clinically diagnosed VAP was associated with lower overall survival than withholding treatment. Antibiotic treatment of VAP diagnosed by invasive (PSB) or semi-invasive (pBAL) techniques was associated with better survival than withholding treatment, although withholding antibiotic therapy was favored as the mortality rate of antibiotic-treated VAP approached 70%.
Conclusions: Invasive or semi-invasive diagnostic techniques should be used to diagnose VAP, guide therapy, and thereby potentially improve survival. A prospective, randomized trial assessing outcome according to diagnostic technique is needed.
Key Words: antibiotic resistance • bronchoscopic protected specimen brush • decision analysis • nonbronchoscopic protected (mini) bronchoalveolar lavage • ventilator-associated pneumonia
Submitted on October 25, 1995
Accepted on May 6, 1996
This article has been cited by other articles:
|
|
 |
|
  S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 388 - 416. [Full Text] [PDF]
|
|
|
|
|
|
D. E. Ost, C. S. Hall, G. Joseph, C. Ginocchio, S. Condon, E. Kao, M. LaRusso, R. Itzla, and A. M. Fein Decision Analysis of Antibiotic and Diagnostic Strategies in Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., November 1, 2003; 168(9): 1060 - 1067. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Chastre and J.-Y. Fagon Ventilator-associated Pneumonia Am. J. Respir. Crit. Care Med., April 1, 2002; 165(7): 867 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Duflo, B. Allaouchiche, R. Debon, F. Bordet, and D. Chassard An Evaluation of the Gram Stain in Protected Bronchoalveolar Lavage Fluid for the Early Diagnosis of Ventilator-Associated Pneumonia Anesth. Analg., February 1, 2001; 92(2): 442 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. SINGH, P. ROGERS, C. W. ATWOOD, M. M. WAGENER, and V. L. YU Short-course Empiric Antibiotic Therapy for Patients with Pulmonary Infiltrates in the Intensive Care Unit . A Proposed Solution for Indiscriminate Antibiotic Prescription Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): 505 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Morehead and S. J. Pinto Ventilator-Associated Pneumonia Arch Intern Med, July 10, 2000; 160(13): 1926 - 1936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. RUIZ, A. TORRES, S. EWIG, M. A. MARCOS, A. ALCÓN, R. LLEDÓ, M. A. ASENJO, and A. MALDONALDO Noninvasive Versus Invasive Microbial Investigation in Ventilator-associated Pneumonia . Evaluation of Outcome Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 119 - 125. [Abstract] [Full Text]
|
|
|
|
 |
|
 N. Singh and V. L. Yu Rational Empiric Antibiotic Prescription in the ICU Chest, May 1, 2000; 117(5): 1496 - 1499. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-Y. Fagon, J. Chastre, M. Wolff, C. Gervais, S. Parer-Aubas, F. Stephan, T. Similowski, A. Mercat, J.-L. Diehl, J.-P. Sollet, et al. Invasive and Noninvasive Strategies for Management of Suspected Ventilator-Associated Pneumonia: A Randomized Trial Ann Intern Med, April 18, 2000; 132(8): 621 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Niederman Bronchoscopy in Nonresolving Nosocomial Pneumonia Chest, April 1, 2000; 117(4_suppl_2): 212S - 218S. [Full Text] [PDF]
|
|
|
|
|
|
P. E. Marik Fever in the ICU Chest, March 1, 2000; 117(3): 855 - 869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Wunderink Mortality and the Diagnosis of Ventilator-associated Pneumonia . A New Direction Am. J. Respir. Crit. Care Med., February 1, 1998; 157(2): 349 - 350. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
