- Poster presentation
Recurrence of Gram-negative nosocomial pneumonia in the critically ill patient following short-course antibiotic therapy
Critical Care volume 11, Article number: P33 (2007)
The optimal duration of antibiotic therapy for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) is not clear. A multicentre randomised controlled trial indicated similar clinical efficacy for 8 versus 15 days of antibiotic therapy for VAP, with less emergence of multiresistant organisms following the shorter course . Pseudomonas aeruginosa is difficult to eradicate, however, and American Thoracic Society guidelines for treatment of HAP due to P. aeruginosa recommend 14 days of therapy . Our aim was to study the rate of recurrence following treatment of Gram-negative HAP in a critically ill population with short-course (typically 5 days) antibiotic therapy.
Materials and methods
We retrospectively reviewed 50 patients treated consecutively with short-course (typically 5 days) antibiotic therapy for Gram-negative HAP in a UK teaching hospital critical care unit from 2004 to 2007. Pneumonia was defined as semi-quantitative respiratory culture (≥2+) of a single Gram-negative isolate, clinical pulmonary infection score ≥6 and initiation of antibiotic therapy. Recurrence of HAP was defined either as relapse (pure growth of the organism causing the initial infection) or reinfection (due to a different organism). Patients were studied until hospital discharge or death.
Demographic and outcome data are summarised in Table 1. The commonest causative organisms were P. aeruginosa (42%), Enterobacter species (14%) and Klebsiella species (14%). Two patients died before completing the initial course of antibiotics.
Chastre J, Wolff M, Fagon JY, et al.: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290: 2588-2598. 10.1001/jama.290.19.2588
American Thoracic Society: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005, 171: 388-416. 10.1164/rccm.200405-644ST
Combes A, Figliolini C, Trouillet JL, et al.: Recurrent Pseudomonas aeruginosa pneumonia in ventilated patients: relapse or reinfection? Crit Care Med 2003, 31: 1102-1107. 10.1097/01.CCM.0000059313.31477.2C
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Pugh, R., Cooke, R. & Dempsey, G. Recurrence of Gram-negative nosocomial pneumonia in the critically ill patient following short-course antibiotic therapy. Crit Care 11, P33 (2007). https://doi.org/10.1186/cc6012
- Antibiotic Therapy
- Nosocomial Pneumonia
- American Thoracic Society
- Critical Care Unit
- Klebsiella Species