Abstract
Although the 2016 American Thoracic Society/Infectious Diseases of America (ATS/IDSA) guidelines recommend a 7-day antibiotic course for hospital-acquired and ventilator-associated pneumonia (VAP), recent trials have challenged this recommendation, particularly for VAP caused by P. aeruginosa. The objective of this study is to provide insights into the optimal duration of antibiotic therapy for VAP caused by non-lactose-fermenting gram-negative bacilli (NF-GNB). This project is a single-center, retrospective cohort study at a community teaching hospital. Patients were included if they were hospitalized with VAP caused by NF-GNB between September 6, 2015 and December 22, 2023. Patients were divided into two groups: those receiving prolonged duration of antibiotic therapy (greater than or equal to 10 days) and those receiving short duration of antibiotic therapy (less than 10 days). The primary endpoint is 30-day mortality from the first day of pathogen-directed therapy. Secondary endpoints include pneumonia recurrence within 30 days, intensive care unit and overall hospital length of stay. The three most prevalent pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia respectively. Both 30-day mortality and recurrence were comparable between groups (17% vs 21%; P = .50) and (26% vs 18%; P = .22) respectively. Patients in the prolonged duration group had a higher hospital length of stay with 35 days as compared to 25 days in the short duration group; P = .01. Thirty-day mortality and pneumonia recurrence rates were similar comparing short vs prolonged antibiotic duration in VAP caused by NF-GNB. Further prospective studies are needed to address the optimal duration of therapy in this group of patients.
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