Early use of imipenem/cilastatin and vancomycin followed by de-escalation versus conventional antimicrobials without de-escalation for patients with hospital-acquired pneumonia in a medical ICU: a randomized clinical trial

Table 3 Treatment outcomes of patients with HAP in the DE and NDE groups

	DE (n= 53)	NDE (n= 55)	Overall (n= 108)	P
Time to adequate antimicrobials, days, mean (SD)^a	1.9 (0.5)	2.8 (0.6)	2.4 (0.4)	0.280
Mortality
Day 14	13 (24.5%)	9 (16.7%)	22 (20.6%)	0.314
Day 28	21 (39.6%)	14 (25.9%)	35 (32.7%)	0.131
Hospital mortality	23 (44.2%)	18 (34.6%)	41 (39.4%)	0.316
ICU stay, days, mean (IQR)^b	21.1 (6-35)	14.1 (6-19)	17.2 (6-19)	0.464^c
Emergence of MDR organisms^d	11 (37.9%)	7 (16.7%)	18 (25.4%)	0.043
Time to development, days, mean (IQR)	19.4 (11-30)	22.7 (9-30)	21 (11-30)	0.108^c
Methicillin-resistant S. aureus	8 (27.6%)	4 (9.5%)	12 (16.9%)	0.059
Gram-negative non-Enterobacteriaceae	4 (13.8%)	5 (11.9%)	9 (12.9%)	> 0.999
S. maltophilia	3 (10.7%)	2 (4.8%)	5 (7.1%)	0.383
Imipenem-resistant A. baumannii	0	2 (4.8%)	2 (2.9%)	0.513
Imipenem-resistant P. aeruginosa	0	1 (2.4%)	1 (1.4%)	> 0.999
ESBL-producing K. pneumonia	1 (3.6%)	0	1 (2.9%)	0.400

Values given as number (%) of patients, unless otherwise stated. DE, de-escalation group; ESBL, extended spectrum β-lactamase; IQR, inter-quartile range; MDR, multidrug-resistant; NDE, non-de-escalation group; SD, standard deviation. ^aTime from initial diagnosis of pneumonia to administration of adequate antimicrobial agent among initially culture-positive patients. ^bExcluding patients who died. ^cWith the Kruskal-Wallis rank test. ^dMDR organisms isolated within 1 month of study enrollment. Patients with initial MDR organisms were excluded (24 patients in the DE and 13 in the NDE group). MDR organisms include methicillin-resistant S. aureus, imipenem-resistant P. aeruginosa, imipenem-resistant A. baumannii, S. maltophilia, and extended-spectrum β-lactamase-producing organisms.

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