Short-Course Antibiotic Agent Therapy for Early Ventilator-Associated Pneumonia in Patients with Trauma

Abstract

Background:

Patients with traumatic injuries who develop ventilator-associated pneumonia (VAP) incur a higher risk of developing multi-drug resistance. Shorter duration of antibiotic agents for early VAP at five days may reduce antibiotic agent exposure without worsening patient outcomes.

Methods:

This retrospective cohort study performed at a Level I Trauma Center included adult (≥16 years old) patients with trauma diagnosed with bronchoalveolar lavage (BAL)-proven early (within four days of intubation) bacterial VAP. Groups were stratified by treatment duration. The primary outcome was the rate of recurrent pneumonia. Secondary outcomes included total antibiotic agent duration, time to recurrent pneumonia, ventilator days, ventilator-free days, intensive care unit and hospital length of stay, re-admission within 30 days, and mortality at discharge and at one year.

Results:

Of the 73 included patients in the analysis, 38 underwent a shortened course (4–5 d) of systemic antibiotic agents, while 35 patients had a standard course (7–8 d). Patients in the short-duration cohort were significantly older with a lower injury severity score (ISS) and were more likely to be extubated at the time of antibiotic agent discontinuation (61% vs. 37%, p = 0.045). There was no difference in the primary outcome; 10 patients had recurrence in the short-duration cohort, while 7 patients had recurrence in the standard cohort (26% vs. 20%, p = 0.522). There were no significant differences in secondary outcomes.

Conclusion:

This study suggests that in patients with trauma diagnosed with early VAP on BAL, five days of antibiotic agent therapy can reduce antibiotic agent use with no adverse impact on pneumonia recurrence rates or other salient outcomes.