P29 – Pathogen Dependent Duration of Antimicrobial Therapy Reduces Recurrent Pneumonia in Trauma Patients

Author(s):
Anastasia Kunac, Alicia Mohr, Miguel Matos, Helen Horng, Ziad Sifri, Robert Lavery, David Livingston, New Jersey Medical School

Background: Ventilator Associated Pneumonia (VAP) is a frequent occurrence in severely injured patients. Patients with prolonged respiratory failure often suffer multiple bouts of VAP; previous studies have shown certain organisms are more likely to be associated with recurrent pneumonia. The optimal duration of antibiotic therapy for VAP remains unknown.

Hypothesis: We hypothesized that treating patients infected with nonfermenting gram negative bacilli (NFGNB), MRSA, and multi-drug resistant (MDR) Enterobacteriaciae for 10 days would mitigate the risk of recurrent VAP.

Methods: Data was collected prospectively and reviewed retrospectively for trauma patients with VAP from 7/12-6/13 following institution of a VAP treatment protocol. VAP was defined as a clinical pneumonia with positive respiratory cultures (BAL with ≥10K organisms). Recurrence was defined as a positive respiratory culture following a full course of antibiotic therapy. The protocol mandated a 10 day course of therapy for NFGNB, MRSA, and MDR Enterobacteriaciae; and a 7 day course for other organisms. Demographic data, ISS, transfusion and microbiology were reviewed. Outcome included ICU and hospital length of stay, ventilator days and survival. A student t-test, chi-square test or logistic regression was used as appropriate.

Results: Following implementation of the VAP protocol, 1420 trauma admissions over a 1-year period were reviewed. Of these, 103(7%) were diagnosed with VAP, and a total of 28(27%) had recurrent VAP. Adherence to the protocol was noted in 75 patients (73%). Outcome data based on compliance with the protocol are compared in the summary table below. There was no difference in age, gender, ISS, units of PRBC transfusion, or mortality between groups.

Conclusions: Protocol driven treatment of post-traumatic VAP is associated with a reduced rate of recurrent VAP, reduced duration of mechanical ventilation, and decreased hospital and ICU length of stay. These data suggest that duration of antimicrobial therapy should be tailored to the offending pathogen. Further prospective studies are warranted to validate these results and to more clearly elucidate the ideal duration of treatment for VAP.