Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment

International audiencePurposeThe optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria.ObjectiveTo demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia.MethodsRandomized, prospective, open, multicenter trial carried out from 1998 to 2002.MeasurementsThe primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90.Results225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90.ConclusionOur results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients

Analyses des conséquences du vieillissement sur la physiologie de l’endomètre à l’aide d’un modèle bovin de génome nucléaire fixé

National audienc

Indications for antibiotic treatment before bacteriology results.

<p>Indications for antibiotic treatment before bacteriology results.</p

Design of the study governing inclusion of a new patient according to BAL bacteriological results and follow up criteria.

<p>Design of the study governing inclusion of a new patient according to BAL bacteriological results and follow up criteria.</p

Patients with documented secondary infections.

<p>Abbreviations:</p>*<p>sensitive,</p>†<p>resistant,</p>**<p>Fischer exact test.</p

Definition of intercurrent adverse events.

*<p>World Health Organisation rating.</p

Exclusion criteria.

<p>Exclusion criteria.</p

Aged endometrium displays perturbations of inflammation-related molecular pathways compared with fertile endometrium in the bovine species

International audienc

Admission characteristics of the study patients according to the duration of antibiotic treatment.

<p>Abbreviations:</p>*<p>RTA: road traffic accident;</p>†<p>SAPS: simplified acute physiological score;</p>‡<p>ICU: intensive care unit;</p>§<p>BAL: bronchoalveolar lavage;</p>**<p>3GC: third generation cephalosporin.</p

Comparisons between patients with and without secondary infections.

<p>Abbreviations:</p>†<p>SAPS: simplified acute physiological score;</p>‡<p>ICU: intensive care unit;</p>§<p>BAL: bronchoalveolar lavage;</p>*<p>3GC: third generation cephalosporin;</p>**<p>all molecules grouped together.</p