Volume 11 Supplement 4

Sepsis 2007

Open Access

Recurrence of Gram-negative nosocomial pneumonia in the critically ill patient following short-course antibiotic therapy

  • Richard Pugh1,
  • Richard Cooke1 and
  • Ged Dempsey1
Critical Care200711(Suppl 4):P33

https://doi.org/10.1186/cc6012

Published: 26 September 2007

Background

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 [1]. 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 [2]. 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.

Results

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.
Table 1

Demographic and outcome data

Demographic data at initial diagnosis

 

   Median age (range) (years)

69.5 (19–84)

   Sex (% male)

78

   Mechanical respiratory support (%)

78

   Median APACHE II score

19

Outcome of patients surviving initial course of antibiotics

 

   Nonresolution (%)

2.1

   Recurrence (%)

10.4 (all relapse)

   Intensive care unit mortality (%)

41.7

   Hospital mortality (%)

60.4

Conclusion

Treatment of Gram-negative HAP in the critically ill patient with short-course antibiotic therapy is associated with a low rate of recurrence (10.4%). This compares favourably with reported recurrence rates of 18–26% following ≥2 weeks of antibiotic therapy for VAP [1, 3, 4].

Authors’ Affiliations

(1)
Department of Critical Care, University Hospital

References

  1. 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.290.19.2588View ArticlePubMedGoogle Scholar
  2. 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.200405-644STView ArticleGoogle Scholar
  3. 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.0000059313.31477.2CView ArticlePubMedGoogle Scholar
  4. Rello J, Mariscal D, March F, et al.: Factors predicting ventilator-associated pneumonia recurrence. Am J Respir Crit Care Med 1998, 157: 912-916.View ArticlePubMedGoogle Scholar

Copyright

© BioMed Central Ltd 2007

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