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1 September 2006 Supplement

Volume 43, Number S2
Clinical Infectious Diseases 2006;43:S75–S81
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4305S2-0007$15.00
DOI: 10.1086/504483
SUPPLEMENT ARTICLE

Use of Quantitative Cultures and Reduced Duration of Antibiotic Regimens for Patients with Ventilator‐Associated Pneumonia to Decrease Resistance in the Intensive Care Unit

Jean Chastre,

Charles‐Edouard Luyt,

Alain Combes, and

Jean‐Louis Trouillet

Service de Réanimation Médicale, Groupe Hospitalier Pitié‐Salpêtrière, Assistance Publique‐Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France

Ventilator‐associated pneumonia is responsible for approximately half of the infections acquired in the intensive care unit and represents one of the principal reasons for the prescription of antibiotics in this setting. Invasive diagnostic methods, including bronchoalveolar lavage and/or protected specimen bronchial brushing, could improve the identification of patients with true bacterial pneumonia and facilitate decisions of whether to treat. These techniques also permit rapid optimization of the choice of antibiotics in patients with proven bacterial infection, once the results of respiratory tract cultures become available, based on the identity of the specific pathogens and their susceptibility to specific antibiotics, to avoid prolonged use of a broader spectrum of antibiotic therapy than is justified by the available information. Because unnecessary prolongation of antibiotic therapy for patients with true bacterial infection may lead to the selection of multidrug‐resistant microorganisms without improving clinical outcome, efforts to reduce the duration of therapy for nosocomial infections are also warranted. An 8‐day regimen can probably be standard for patients with ventilator‐associated pneumonia. Possible exceptions to this recommendation include immunosuppressed patients, patients who are bacteremic or whose initial antibiotic therapy was not appropriate for the causative microorganism(s), and patients whose infection is with very difficult‐to‐treat microorganisms and show no improvement in clinical signs of infection.

Reprints or correspondence: Dr. Jean Chastre, Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié‐Salpêtrière, 47‐83 Blvd. de l’Hôpital, 75651 Paris Cedex 13, France ().

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Online publication date: 1-Sep-2006.
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