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1、Comparisonof8vs15DaysofAntibioticsTherapyforVentilator-AssociatedPneumoniainadultJAMA,November19,2003Vol.290,No.19R2曾政森加護病房July2005IntroductionHospitalsandparticularlyICUsandrapiddisseminationofmultiresistantbacteria.Nosocomialpneumoniainpatientsrequiring

2、ventilatorrepresentsoneoftheprinciplereasonsfortheprescriptionofantibioticsinICU.TheoptimaldurationofantibioticTx.forVAP?ShorteningthedurationofantibioticsTx.?Patient’sprognosis?Riskofrelapse?ObjectiveTodeterminewhether8daysisaseffectiveas15daysofantibiot

3、ictreatmentofpatientswithmicrobiologicallyprovenVAP!StudydesignandorganizationRandomized,double-blindtrialon2parallelgroupsin51ICUsinFrance(May1999~June2002)InclusioncriteriaICUpatients,intubatedandreceivedventilator>48hrOlderthan18y/oClinicalsuspicionofV

4、APPositivequantitativeculturesofdistalpulmonarysecretionsamples,obtainedbybronchoscopeInstigationwithin24hrfollowingbronchoscopeofappropriateempiricalantibioticsClinicalsuspicionofVAPNewandpersistentinfiltrateonCXR,andWithatleast1ofthefollowing:purulenttr

5、achealsecretions,BT>38.3oC,WBC>10000/μLPositivequantitativeculturesofdistallungsecretionBronchoscopiclavage:≧104CFU/mlBronchoscopicbrushing:≧103CFU/mlExclusioncriteriaPregnancyPatientswhowereenrolledinothertrialLittlechangeofsurvival(SAPSII≧65)Neutropenia

6、(WBC<1000/μLorNeur.<500/μL)AIDSReceiveimmunosuppressantsorlong-termsteroidtherapyConcomitantextrapulmonaryinfectionRandomizationPatientswererandomlyassignedtoreceiveantibioticsfor8or15days3daysafterbronchoscope.Thepathogenswerewellcoveredbyinitialempirica

7、lantibiotics.Computer-generatedrandom-numbertable.AntibioticstreatmentDrugselectionwaslefttothediscretionofthetreatingphysicians.Atleastanaminoglycosideorafluoroquinoloneandabroad-spectrumbetalactamantimicrobialagentConvertthisinitialregimenintoanarrowspe

8、ctrumtherapybasedoncultureresultsFollow-upanddefinitionBT,WBC,PaO2/FiO2,trachealsecretions,ventilatorstatus,vitalsignsandODINscoredailyF/USOFAandCXRonday3,7,14,21and28Bronchoscopewasperformedbeforetheintroductionof