Immediate vs. culture-initiated antibiotic therapy in suspected non-severe ventilator-associated pneumonia: a before–after study (DELAVAP)

Annals of Intensive Care

Table 2 Antibiotic use and other outcome measures

	Immediate n = 44	Conservative n = 43	p value
Days alive without AT by day 28, median [IQR]	16.0 [0.0–20.0]	18.0 [0.0–21.0]	0.50
Days alive without broad-spectrum AT by day 28, median [IQR]	23.5 [5.0–26.0]	25.0 [0.0–28.0]	0.53
Days alive without carbapenem by day 28, median [IQR]	28.0 [9.0–28.0]	28.0 [0.0–28.0]	0.65
iMV duration, days, median [95% confidence interval] HR [95%CI]	9.0 [6.0–24.0] 1.1 [0.7–1.8]	9.0 [6.0–19.0]	0.65
Ventilator-free days, median [IQR]	18.5 [0.0–23.0]	16.0 [0.0–22.0]	0.99
ICU stay, days, median [95% confidence interval]	9.0 [6.0–14.0]	13.0 [8.0–17.0]	0.71
Day-28 mortality, n (%) HR [95%CI]	11 (25.0) 0.8 [0.4–2.0]	11 (25.6)	0.71
VAP-related abscess, n (%)	0	2 (4.6)	0.24
VAP-related bacteraemia, n (%)	0	2 (4.6)	0.24
Subsequent VAP, n (%)
Recurrence^a	3 (6.8)	2 (4.6)	0.11
Superinfection^a	2 (4.5)	0 (0)
First VAP after suspected unconfirmed VAP	0 (0)	4 (9.3)
MRB^b, n (%)	0	0	-
Clostridium difficile infections, n (%)	0	0	-
Antibiotic allergy, n (%)	2 (4.5)	0	0.49

ICU: intensive care unit; iMV: endotracheal mechanical ventilation; HR: hazard ratio; 95%CI: 95% confidence interval; VAP: ventilator-associated pneumonia
^aRecurrence was defined as improvement in the manifestations (fever, secretions, vasopressor needs, inflammatory biomarkers, and chest radiograph infiltrates) after 7-day treatment with at least one antibiotic active on all documented bacteria, followed by the return of these manifestations and growth in new distal respiratory specimens of at least one bacterial species in significant concentrations
The same scenario with growth of at least one of the initial causative bacteria defined relapse (n = 0); otherwise, it was considered to be a superinfection [25]
^bMRB indicates any of the following multiresistant bacteria: methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediate Staphylococcus aureus (GISA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-e), carbapenemase-producing Enterobacterales (CPE), and imipenem-resistant Acinetobacter baumannii (IRAB)