The following is a summary of “Immediate vs. culture-initiated antibiotic therapy in suspected non-severe ventilator-associated pneumonia: a before–after study (DELAVAP),” published in the February 2024 issue of Critical Care by Martin et al.
Choosing the optimal timing for antibiotic therapy (AT) in suspected ventilator-associated pneumonia (VAP) is crucial, balancing unnecessary treatment against potential delays in critically ill patients.
Researchers conducted a retrospective study to compare the impact of immediate versus culture-guided AT on antibiotic usage, treatment suitability, and patient outcomes in suspected non-severe VAP.
They conducted a single-center, before-after study that enrolled consecutive patients experiencing their first suspected non-severe VAP episode (no shock requiring vasopressor therapy or severe acute respiratory distress syndrome). In 2019, AT was initiated immediately after respiratory sampling, while in 2022, it commenced upon culture positivity (a conservative strategy). The primary endpoint assessed was the number of days survived without receiving AT by day 28. Secondary endpoints included the duration of mechanical ventilation, day-28 mortality, and the appropriateness of AT use (whether AT was actively needed or could be spared).
The results showed that immediate and conservative strategies were applied in 44 and 43 patients. Conservative and immediate AT were associated with similar days alive without AT (median (IQR), 18.0 [0–21.0] vs 16.0 [0–20.0], P=0.50) and without broad-spectrum AT (P=0.53) by day 28. AT was more often suitable in the conservative group (88.4% vs 63.6%, P=0.01), in which 27.9% of patients received no AT. No significant differences were found for mechanical ventilation duration (median [95%CI], 9.0 [6–19] vs 9.0 [6–24] days, P=0.65) or day-28 mortality (HR [95%CI], 0.85 [0.4–2.0], P=0.71).
Investigators concluded that waiting for test results before antibiotic treatment in suspected non-severe VAP did not decrease antibiotic use but improved treatment accuracy, suggesting further studies were needed.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01243-z