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1 February 2007

Volume 44, Number 3
Clinical Infectious Diseases 2007;44:382–387
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4403-0012$15.00
DOI: 10.1086/510587
MAJOR ARTICLE

Direct E‐Test (AB Biodisk) of Respiratory Samples Improves Antimicrobial Use in Ventilator‐Associated Pneumonia

Emilio Bouza,1

María V. Torres,1

Celina Radice,1

Emilia Cercenado,1

Roberto de Diego,2

Carlos Sánchez‐Carrillo,1 and

Patricia Muñoz1

Departments of 1Clinical Microbiology and Infectious Diseases and 2Anesthesia, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain

Background.Ventilator‐associated pneumonia is the most frequently observed nosocomial infection in intensive care units, and it is associated with high morbidity and mortality. Early microbiological diagnosis and the initial administration of appropriate antimicrobial therapy are associated with decreased mortality and potentially reduced costs. Our study evaluates the clinical and financial impact of performing rapid antimicrobial susceptibility tests directly on samples obtained from the lower respiratory tract.

Methods.A prospective, randomized study was performed over a 2‐year period. Patients who had a lower respiratory tract infection that was acquired during mechanical ventilation and for whom samples obtained from the respiratory tract were sent for culture were randomized to 1 of 2 groups. Samples were cultured for the control group, and results were reported using standard procedures. Samples were also cultured for the test subject group using standard procedures, but in addition, a rapid antibiogram was immediately performed by placing E‐test antibiotic strips (AB Biodisk) directly on respiratory tract samples. Patients in the E‐test group received a preliminary laboratory report when it became available. The 2 patient groups were compared according to the following variables: type and severity of underlying conditions, total days of antimicrobial use, number of defined daily doses, cost of acquisition of the antimicrobial agent per episode, days of fever, days receiving mechanical ventilation, days in the intensive care unit, incidence of Clostridium difficile–associated diarrhea, and mortality.

Results.Reporting a rapid E‐test was associated with fewer days of fever, fewer days of antibiotic administration until resolution of the episode of ventilator‐associated pneumonia, decreased antibiotic consumption, less C. difficile–associated diarrhea, lower costs of antimicrobial agents, and fewer days receiving mechanical ventilation.

Conclusions.A rapid E‐test of respiratory tract samples improves antimicrobial use in cases of ventilator‐associated pneumonia.

Received 28 June 2006; accepted 19 October 2006; electronically published 3 January 2007.

  • (See the editorial commentary by Kollef on pages 388–90)

Reprints or correspondence: Dr. Emilio Bouza, Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007, Madrid, Spain ().

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Emilio Bouza, Almudena Burillo. (2009) Advances in the prevention and management of ventilator-associated pneumonia. Current Opinion in Infectious Diseases 22:4, 345-351
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Evelina Tacconelli, Giulia De Angelis. (2009) Pneumonia due to methicillin-resistant Staphylococcus aureus: clinical features, diagnosis and management. Current Opinion in Pulmonary Medicine 15:3, 218-222
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Alexandros P Grammatikos, Ilias I Siempos, Argyris Michalopoulos, Matthew E Falagas. (2009) Optimal duration of the antimicrobial treatment of ventilator-acquired pneumonia. Expert Review of Anti-infective Therapy 6:6, 861-866
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David L. Paterson. (2008) Impact of Antibiotic Resistance in Gram‐Negative Bacilli on Empirical and Definitive Antibiotic Therapy. Clinical Infectious Diseases 47:s1, S14-S20
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Ethan Rubinstein, Marin H. Kollef, and Dilip Nathwani. (2008) Pneumonia Caused by Methicillin‐Resistant Staphylococcus aureus. Clinical Infectious Diseases 46:s5, S378-S385
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Thiago Lisboa, Jordi Rello. (2008) Diagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach?. Current Opinion in Infectious Diseases 21:2, 174-178
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Graeme Forrest. (2008) Is there a role for antimicrobial management in organ transplantation?. Current Opinion in Organ Transplantation 12:6, 604-609
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Pramod M. Shah. (2007) Direct Susceptibility Testing of Respiratory Samples. Clinical Infectious Diseases 45:3, 401-401
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Emilio Bouza, María V. Torres, and Patricia Muñoz. (2007) Reply to Shah. Clinical Infectious Diseases 45:3, 401-403
Online publication date: 1-Aug-2007.
Citation-Full Text-PDF Version (175 kB)
Marin H. Kollef. (2007) Editorial Commentary: Moving Towards Real‐Time Antimicrobial Management of Ventilator‐Associated Pneumonia. Clinical Infectious Diseases 44:3, 388-390
Online publication date: 1-Feb-2007.
Citation-Full Text-PDF Version (161 kB)

  • Presented in part: 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., December 2005 (abstract D‐51).

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