Research

Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study

Saad Nseir^1,2 , Raphaël Favory¹ , Elsa Jozefowicz³ , Franck Decamps⁴ , Florent Dewavrin⁵ , Guillaume Brunin⁶ , Christophe Di Pompeo² , Daniel Mathieu¹ and Alain Durocher^1,2 for the VAT Study Group

¹Réanimation Médicale, boulevard du Pr Leclercq, Hôpital Calmette, CHRU de Lille, 59037 Lille Cedex, France

²Laboratoire d'Evaluation Médicale, EA 2690, Université Lille II, 1 place de Verdun, 59045 Lille, France

³Centre d'Investigation Clinique, boulevard du Pr Leclercq Hôpital Cardiologique, CHRU de Lille, 59037 Lille Cedex, France

⁴Réanimation Neurochirurgicale, CHRU de Lille, Hôpital R. Salengro, CHRU de Lille, 59037 Lille Cedex, France

⁵Réanimation Polyvalente, Hôpital Régional, Avenue Désandrouin, BP 479, 59322 Valenciennes Cedex, France

⁶Réanimation Polyvalente, CH Duchenne, rue Jacques Monod, BP 609, 62321 Boulogne Sur Mer, France

author email corresponding author email

Critical Care 2008, 12:R62doi:10.1186/cc6890

Published:	2 May 2008

See related commentary by Craven, http://ccforum.com/content/12/3/157

Abstract

Introduction

Ventilator-associated tracheobronchitis (VAT) is associated with increased duration of mechanical ventilation. We hypothesized that, in patients with VAT, antibiotic treatment would be associated with reduced duration of mechanical ventilation.

Methods

We conducted a prospective, randomized, controlled, unblinded, multicenter study. Patients were randomly assigned (1:1) to receive or not receive intravenous antibiotics for 8 days. Patients with ventilator-associated pneumonia (VAP) prior to VAT and those with severe immunosuppression were not eligible. The trial was stopped early because a planned interim analysis found a significant difference in intensive care unit (ICU) mortality.

Results

Fifty-eight patients were randomly assigned. Patient characteristics were similar in the antibiotic (n = 22) and no antibiotic (n = 36) groups. Pseudomonas aeruginosa was identified in 32% of VAT episodes. Although no difference was found in mechanical ventilation duration and length of ICU stay, mechanical ventilation-free days were significantly higher (median [interquartile range], 12 [8 to 24] versus 2 [0 to 6] days, P < 0.001) in the antibiotic group than in the no antibiotic group. In addition, subsequent VAP (13% versus 47%, P = 0.011, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04 to 0.70) and ICU mortality (18% versus 47%, P = 0.047, OR 0.24, 95% CI 0.07 to 0.88) rates were significantly lower in the antibiotic group than in the no antibiotic group. Similar results were found after exclusion of patients with do-not-resuscitate orders and those randomly assigned to the no antibiotic group but who received antibiotics for infections other than VAT or subsequent VAP.

Conclusion

In patients with VAT, antimicrobial treatment is associated with a greater number of days free of mechanical ventilation and lower rates of VAP and ICU mortality. However, antibiotic treatment has no significant impact on total duration of mechanical ventilation.

Trial registration

ClinicalTrials.gov, number NCT00122057.