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De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate

OBJECTIVE: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study. SETTING: Multidisciplinary intensive care unit. PATIENTS AND PARTICIPANTS: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bro...

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Autores principales: Giantsou, Elpis, Liratzopoulos, Nikolaos, Efraimidou, Eleni, Panopoulou, Maria, Alepopoulou, Eleonora, Kartali-Ktenidou, Sofia, Manolas, Konstantinos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer-Verlag 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095354/
https://www.ncbi.nlm.nih.gov/pubmed/17549458
http://dx.doi.org/10.1007/s00134-007-0619-x
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author Giantsou, Elpis
Liratzopoulos, Nikolaos
Efraimidou, Eleni
Panopoulou, Maria
Alepopoulou, Eleonora
Kartali-Ktenidou, Sofia
Manolas, Konstantinos
author_facet Giantsou, Elpis
Liratzopoulos, Nikolaos
Efraimidou, Eleni
Panopoulou, Maria
Alepopoulou, Eleonora
Kartali-Ktenidou, Sofia
Manolas, Konstantinos
author_sort Giantsou, Elpis
collection PubMed
description OBJECTIVE: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study. SETTING: Multidisciplinary intensive care unit. PATIENTS AND PARTICIPANTS: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage (BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de-escalation therapy by BAL or tracheal aspirate. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Antibiotic therapy was de-escalated in 58 patients (40.5%), who had decreased mortality at day 15 (5.1% vs. 31.7%) and day 28 (12% vs. 43.5%) and shorter intensive care unit (17.2 ± 1.2 vs. 22.7 ± 6.3 days) and hospital (23.7 ± 2.8 vs. 29.8 ± 11.1 days) stay (p < 0.05). Of the 81 patients assigned to tracheal aspirate, the 17 (21%) who achieved de-escalation of therapy had reduced 15-day mortality (5.8% vs. 34.3%), reduced 28-day mortality (11.6% vs. 45.3%), and shorter intensive care unit (17.2 ± 1.6 vs. 22.4 ± 6.4 days) and hospital (23.1 ± 4.4 vs. 29.9 ± 11.1 days) stay (p < 0.05). Of the 62 patients assigned to BAL, the 41 (66.1%) who achieved de-escalation of therapy had decreased 15-day mortality (4.8% vs. 23.8%), decreased 28-day mortality (12.1% vs. 38%), and shorter intensive care unit (17.2 ± 1.1 vs. 23.2 ± 6 days) and hospital (23.8 ± 2.4 vs. 29.8 ± 11.4 days) stay (p < 0.05). CONCLUSIONS: For patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy.
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spelling pubmed-70953542020-03-26 De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate Giantsou, Elpis Liratzopoulos, Nikolaos Efraimidou, Eleni Panopoulou, Maria Alepopoulou, Eleonora Kartali-Ktenidou, Sofia Manolas, Konstantinos Intensive Care Med Original OBJECTIVE: To assess outcomes with de-escalation therapy in ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study. SETTING: Multidisciplinary intensive care unit. PATIENTS AND PARTICIPANTS: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage (BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de-escalation therapy by BAL or tracheal aspirate. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Antibiotic therapy was de-escalated in 58 patients (40.5%), who had decreased mortality at day 15 (5.1% vs. 31.7%) and day 28 (12% vs. 43.5%) and shorter intensive care unit (17.2 ± 1.2 vs. 22.7 ± 6.3 days) and hospital (23.7 ± 2.8 vs. 29.8 ± 11.1 days) stay (p < 0.05). Of the 81 patients assigned to tracheal aspirate, the 17 (21%) who achieved de-escalation of therapy had reduced 15-day mortality (5.8% vs. 34.3%), reduced 28-day mortality (11.6% vs. 45.3%), and shorter intensive care unit (17.2 ± 1.6 vs. 22.4 ± 6.4 days) and hospital (23.1 ± 4.4 vs. 29.9 ± 11.1 days) stay (p < 0.05). Of the 62 patients assigned to BAL, the 41 (66.1%) who achieved de-escalation of therapy had decreased 15-day mortality (4.8% vs. 23.8%), decreased 28-day mortality (12.1% vs. 38%), and shorter intensive care unit (17.2 ± 1.1 vs. 23.2 ± 6 days) and hospital (23.8 ± 2.4 vs. 29.8 ± 11.4 days) stay (p < 0.05). CONCLUSIONS: For patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy. Springer-Verlag 2007-06-05 2007 /pmc/articles/PMC7095354/ /pubmed/17549458 http://dx.doi.org/10.1007/s00134-007-0619-x Text en © Springer-Verlag 2007 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original
Giantsou, Elpis
Liratzopoulos, Nikolaos
Efraimidou, Eleni
Panopoulou, Maria
Alepopoulou, Eleonora
Kartali-Ktenidou, Sofia
Manolas, Konstantinos
De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title_full De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title_fullStr De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title_full_unstemmed De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title_short De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
title_sort de-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095354/
https://www.ncbi.nlm.nih.gov/pubmed/17549458
http://dx.doi.org/10.1007/s00134-007-0619-x
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