Impact of Pathogen-Specific Antibiotic on Clinical Outcomes in Ventilator-Associated Pneumonia

BACKGROUND

Ventilator-associated pneumonia (VAP) is a prime cause of morbidity and mortality in intensive care settings. Institution of specific antibiotic therapy in VAP could be instrumental in reducing intensive care unit (ICU) utilisation rates in terms of days on ventilator and days admitted besides improving patient outcomes.

METHODS

In a prospective study on 100 VAP patients, endotracheal aspirates from cases were processed microbiologically according to standard procedures. Patients in whom empiric antibiotics were modified to pathogen-specific antibiotics following susceptibility report, were compared with the group where pathogen-specific antibiotics were not administered. Outcomes were measured in terms of duration of mechanical ventilation, length of ICU stay and mortality rates in both study groups.

RESULTS

Among the 100 study cases, 84 % were changed to pathogen-specific antibiotic therapy in our ICU. The average duration of mechanical ventilation was comparable in both groups, 7.5 days in patients on administered targeted therapy, as compared to 8 days in patients whose antibiotics were not changed. Similarly, mean length of ICU stay was marginally shorter (10 days) in the former group of patients as compared to the latter (10.5 days). Mortality rates were significantly associated with a change in antibiotic therapy. A staggering 50 % patients belonging to the non-compliant group died in the ICU, as opposed to 38.4 % in the group whose antibiotics were changed (P < 0.05).

CONCLUSIONS

Therapy in VAP should be modified according to microbiological susceptibility reports so as to shorten days in ICU, shorten the duration on invasive ventilation and bring down mortality rates in VAP.