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Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

  1. Richard Pugh1,*,
  2. Chris Grant2,
  3. Richard PD Cooke3,
  4. Ged Dempsey2

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 5 OCT 2011

Assessed as up-to-date: 9 MAR 2011

DOI: 10.1002/14651858.CD007577.pub2


How to Cite

Pugh R, Grant C, Cooke RPD, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007577. DOI: 10.1002/14651858.CD007577.pub2.

Author Information

  1. 1

    Glan Clwyd Hospital, Department of Anaesthetics, Rhyl, Denbighshire, UK

  2. 2

    University Hospital Aintree, Department of Critical Care, Liverpool, Merseyside, UK

  3. 3

    University Hospital Aintree, Department of Microbiology, Liverpool, Merseyside, UK

*Richard Pugh, Department of Anaesthetics, Glan Clwyd Hospital, Rhyl, Denbighshire, LL18 5UJ, UK. pughr@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 5 OCT 2011

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Bouadma 2010 {published data only}
  • Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010;375(9713):463-74.
Chastre 2003a {published data only}
  • Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290(19):2588-98.
Fekih Hassen 2009 {published data only}
  • Fekih Hassen M, Ayed S, Ben Sik Ali H, Gharbi R, Marghli S, Elatrous S. Duration of antibiotic therapy for ventilator-associated pneumonia: comparison of 7 and 10 days. A pilot study. Annales Françaises d'Anesthésie et de Réanimation 2009;28(1):16-23.
Medina 2007 {published and unpublished data}
  • Medina JC, Perez Protto SE, Paciel D, Pontet J, Saldun P, Berro M. Antibiotic treatment for the ventilator-associated pneumonia: 8 vs. 12 days randomized trial preliminary data. Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL. 2007.
Micek 2004 {published data only}
  • Micek ST,  Ward S,  Fraser VJ,  Kollef MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004;125(5):1791-9.
Pontet 2007 {published and unpublished data}
  • Pontet J, Paciel D, Olivera W, Bentancourt S, Cancela M, Gervas J. Procalcitonin (PCT) guided antibiotic treatment in ventilator associated pneumonia (VAP). Multi-centre, clinical prospective, randomized-controlled study. American Thoracic Society International Conference, San Francisco, California, USA. 2007:A76.
Singh 2000 {published data only}
  • Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. American Journal of Respiratory and Critical Care Medicine 2000;162:505-11.
Stolz 2009a {published and unpublished data}
  • Stolz D,  Smyrnios N,  Eggimann P,  Pargger H,  Thakkar N,  Siegemund M,  et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. European Respiratory Journal 2009;34(6):1364-75.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Cai 2001 {published data only}
  • Cai S, Zhang J, Qian G. Impact of quantitative and qualitative pathogen culture on the outcome of ventilator-associated pneumonia. Zhonghua Jie He He Hu Xi Za Zhi 2001;24(8):494-7.
CCCTG 2006 {published data only}
Chastre 2003b {published data only}
  • Chastre J, Wolff M, Fagon JY, Chevret S. Comparison of two durations of antibiotic therapy to treat ventilator-associated pneumonia (VAP). American Thoracic Society Meeting, Seattle, Washington. 2003:A015.
Fagon 2000 {published data only}
  • Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stéphan F, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Annals of Internal Medicine 2000;132(8):621-30.
Hochreiter 2009 {published data only (unpublished sought but not used)}
  • Hochreiter M,  Köhler T,  Schweiger AM,  Keck FS,  Bein B,  von Spiegel T,  et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Critical Care 2009;13(3):R83.
Ibrahim 2001 {published data only}
  • Ibrahim EH,  Ward S,  Sherman G,  Schaiff R,  Fraser VJ,  Kollef MH. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Critical Care Medicine 2001;29(6):1109-15.
Kim 2009 {published data only}
  • Kim JW, Chung J, Jang HJ, Hong SB, Lim CM, Koh Y. De-escalation of antibiotics in critically ill patients with hospital-acquired pneumonia. Respirology 2009;14:A129.
Kollef 2005 {published data only}
  • Kollef MH,  Kollef KE. Antibiotic utilization and outcomes for patients with clinically suspected ventilator-associated pneumonia and negative quantitative BAL culture results. Chest 2005;128:2706-13.
Maldonado-Ortiz 2004 {published data only (unpublished sought but not used)}
  • Maldonado-Ortiz EA, Niederman MS, Nacul F, Rodríguez A, Ceballos S, Osorio J. How long is enough to treat ventilator associated pneumonia? A randomized pilot study: the Latinoamerican experience. Chest 2004;126(Suppl 4):717.
Nobre 2008 {published data only}
  • Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. American Journal of Respiratory and Critical Care Medicine 2008;177(5):498-505.
Peery 2001 {published data only}
  • Peery C, Chendrasekhar A, Moorman DW, Timberlake GA. Ventilator-associated pneumonia therapy: protected specimen brushing versus tracheal aspirate data. Journal of Applied Research 2001;1(2):1.
Rello 2004 {published data only}
  • Rello J,  Vidaur L,  Sandiumenge A,  Rodríguez A,  Gualis B,  Boque C,  et al. De-escalation therapy in ventilator-associated pneumonia. Critical Care Medicine 2004;32(11):2183-90.
Sanchez-Nieto 1998 {published data only}
  • Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, El-Ebiary M, Carrillo A, Ruiz J, et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. American Journal of Respiratory and Critical Care Medicine 1998;157(2):371-6.
Schroeder 2007 {published data only (unpublished sought but not used)}
  • Schroeder S,  Hochreiter M,  Koehler T,  Schweiger AM,  Bein B,  Keck FS,  et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbeck's Archives of Surgery 2009;394:221-6.
Singh 1998 {published data only}
  • Singh N. Short-course empiric antibiotic therapy for suspected nosocomial pneumonia: a proposed solution for indiscriminate antibiotic prescription for pulmonary infiltrates in the ICU. Annual Meeting of the Infectious Disease Society of America, Denver, Colorado. 1998.
Sole 2000 {published data only}
  • Sole VJ, Fernandez JA, Benitez AB, Cardenosa Cendrero JA, Rodriguez de CF. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Critical Care Medicine 2000;28(8):2737-41.
Stolz 2009b {published data only}
  • Stolz D, Smyrnios N, Eggimann P, Pargger H, Thakkar N, Siegemund M, et al. Procalcitonin for antibiotic de-escalation in ventilator associated pneumonia - a randomized study. European Resiratory Society Annual Congress, Vienna. 2009:2798.
Svoboda 2007 {published data only}
  • Svoboda P,  Kantorová I,  Scheer P,  Radvanova J,  Radvan M. Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery?. Hepatogastroenterology 2007;54:359-63.
Wolff 2003 {published data only}
  • Wolff M, Chastre J, Fagon JY, Chevret S. Comparison of two durations of antibiotic therapy for ventilator-associated pneumonia (VAP) caused by non-fermenting gram negative bacilli (NF-GNB). American Thoracic Society Meeting Seattle, Washington. 2003:A860.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
NCT00934011 {unpublished data only}
  • Comparative study of C-reactive protein versus procalcitonin to guide antibiotic therapy in patients with severe sepsis and septic shock admitted to the Intensive Care Unit. Ongoing study September 2009.
NCT00987818 {unpublished data only}
  • Reduction of antibiotic use in the ICU: procalcitonin guided versus conventional antibiotic therapy in patients with sepsis in the ICU. Ongoing study October 2009.
PASS {unpublished data only}
  • The procalcitonin and survival study (PASS). Ongoing study In progress.
Pro-SEPS {unpublished data only}
  • Randomised multicenter prospective study of procalcitonin-guided treatment on antibiotic use and outcome in severe sepsis ICU patients without obvious infection. Ongoing study December 2007.
SAPS {unpublished data only}
  • Safety and efficacy of procalcitonin guided antibiotic therapy in adult intensive care units (ICU's) (SAPS). Ongoing study November 2009.
SISPCT {unpublished data only}
  • Placebo-controlled trial of sodium selenite and procalcitonin guided antimicrobial therapy in severe sepsis (SISPCT). Ongoing study November 2009.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
ATS/IDSA 2005
  • American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical Care Medicine 2005;171(4):388-416.
Bignardi 1998
BSAC 2008
  • Masterton RG,  Galloway A,  French G,  Street M,  Armstrong J,  Brown E,  et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy 2008;62(1):5-34.
Chastre 2002
Combes 2007
  • Combes A, Luyt CE, Fagon JY, Wolff M, Trouillet JL, Chastre J. Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Critical Care Medicine 2007;35(1):146-54.
Dennesen 2001
  • Dennesen PJ, van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine 2001;163(6):1371-5.
Dugan 2003
El Solh 2007
  • El Solh AA, Choi G, Schultz MJ, Pineda LA, Mankowski C. Clinical and hemostatic responses to treatment in ventilator-associated pneumonia: role of bacterial pathogens. Critical Care Medicine 2007;35(2):490-6.
Grammatikos 2008
  • Grammatikos AP, Siempos II, Michalopoulos A, Falagas ME. Optimal duration of the antimicrobial treatment of ventilator-acquired pneumonia. Expert Review of Anti-infective Therapy 2008;6(6):861-6.
Higgins 2002
Kohlenberg 2010
  • Kohlenberg A, Schwab F, Behnke M, Geffers C, Gastmeier P. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Medicine 2010;36(6):971-8.
Kollef 1995
Kopterides 2010
  • Kopterides P, Siempos II, Tsangaris I, Tsantes A, Armaganidis A. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Critical Care Medicine 2010;38(11):2229-41.
Lefebvre 2011
  • Lefebvre C, Manheimer E, Glanville J. Chapter 6. Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from www.cochrane-handbook.org. Chichester, UK: Wiley-Blackwell, 2011.
Luna 2003
  • Luna CM,  Blanzaco D,  Niederman MS,  Matarucco W,  Baredes NC,  Desmery P,  et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Critical Care Medicine 2003;31(3):676-82.
Mueller 2007
  • Mueller EW,  Croce MA,  Boucher BA,  Hanes SD,  Wood GC,  Swanson JM,  et al. Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. Journal of Trauma 2007;63(6):1329-37.
Pepin 2005
  • Pépin J,  Saheb N,  Coulombe MA,  Alary ME,  Corriveau MP,  Authier S,  et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clinical Infectious Diseases 2005;41(9):1254-60.
ProBac
  • ProBac - use of procalcitonin level as part of a decision tree to discontinue antibiotics when started empirically in the ICU in hemodynamically stable patients with no site of infection identified (Terminated). http://clinicaltrials.gov/ct2/show/NCT00407147 (date accessed 20 April 2011).
Rello 2002
RevMan 2011
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Richards 2000
  • Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infection Control and Hospital Epidemiology 2000;21(8):510-5.
Rotstein 2008
  • Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Canadian Journal of Infectious Diseases and Medical Microbiology 2008;19(1):19-53.
Safdar 2005
Stern 2011
  • Sterne JAC, Egger M, Moher D (editors). Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from www.cochrane-handbook.org. Chichester: The Cochrane Collaboration, 2011.
Vincent 1995
  • Vincent JL,  Bihari DJ,  Suter PM,  Bruining HA,  White J,  Nicolas-Chanoin MH,  et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274(8):639-44.
Vincent 2009
  • Vincent JL,  Rello J,  Marshall J,  Silva E,  Anzueto A,  Martin CD,  et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302(21):2323-9.
Visscher 2008
  • Visscher S, Schurink CA, Melsen WG, Lucas PJ, Bonten MJ. Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients. Intensive Care Medicine 2008;34(4):692-9.
Zhuo 2008
  • Zhuo H, Yang K, Lynch SV, Dotson RH, Glidden DV, Singh G, et al. Increased mortality of ventilated patients with endotracheal Pseudomonas aeruginosa without clinical signs of infection. Critical Care Medicine 2008;36(9):2495-503.