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Clinical Investigations in Critical CareA Randomized Controlled Trial of an Antibiotic Discontinuation Policy for Clinically Suspected Ventilator-Associated Pneumonia
Section snippets
Study Location and Patients
The study was conducted at a university-affiliated urban teaching hospital: Barnes-Jewish Hospital (1,400 beds) in St. Louis, MO. During a 14-month period (April 2002 to July 2003), all patients admitted to the medical ICU (19 beds) were potentially eligible for this investigation. Patients were entered into the study if they were > 18 years old and received antibiotic treatment for VAP. Patients were excluded from participation if they were transferred to the medical ICU due to lack of
Patients
A total of 290 consecutive patients treated with antibiotics for presumed VAP completed the clinical trial (Fig 1). The mean age of the patients was 59.9 ± 17.8 years (range, 19 to 97 years); 145 patients (50.0%) were men, and 145 patients (50.0%) were women. The mean APACHE II score of the entire study cohort was 23.0 ± 9.2 (range, 4 to 50), and the mean clinical pulmonary infection score for the study cohort was 7.1 ± 0.9 (range, 6 to 9). Patients in the two treatment groups were
Discussion
We demonstrated that an antibiotic discontinuation policy directed at the treatment of clinically suspected VAP was associated with the administration of statistically shorter durations of antibiotic therapy. On average, patients managed with the antibiotic discontinuation policy received 2 fewer days of antibiotic treatment compared to patients in the conventional group. No differences in hospital mortality or the durations of intensive care and hospitalization were observed between the two
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This investigation was supported in part by the Barnes-Jewish Hospital Foundation and an unrestricted grant from Elan Pharmaceuticals.