The PROPHY-VAP study, a multicenter, randomized trial in eight French hospitals, evaluated the efficacy of a single dose of ceftriaxone in preventing early ventilator-associated pneumonia (VAP) in 319 mechanically ventilated, comatose patients with acute brain injury. Patients were assigned to either ceftriaxone or placebo groups. The study found a significant reduction in early VAP incidence in the ceftriaxone group (14%) compared to the placebo group (32%), with no adverse effects. This led to the recommendation of including ceftriaxone in VAP prevention protocols for such patients.
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Sepsis & Septic Shock
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62-year-old male with history of IgM myeloma with significant extramedullary disease complicated by renal failure, previously on daratumumab and lenalitomide with progression, now status post hyperCVAD. Presented with respiratory distress, neutropenic sepsis, streptococcus agalactiea, oral thrush, and bilateral pulmonary infiltrates. Patient was initially placed on BiPAP but required to be intubated and placed on mechanical ventilation with protective lung strategy 🫁.
Chest x-ray is shown below:
Bronchoscopy was done and BAL was sent for PJP and other tests. There were multiple mucosal white spots scattered in trachea and throughout the bronchial tree bilaterally as shown in these images:
What do you think?
Inhaled Amikacin for the Prevention of VAP
In a multicenter, double-blind, randomized controlled trial involving critically ill adults undergoing mechanical ventilation for over 72 hours, patients were administered either inhaled amikacin (20 mg/kg ideal body weight daily) or a placebo for three days. The study aimed to determine the efficacy of preventive inhaled antibiotics in reducing ventilator-associated pneumonia.
Out of the 847 patients analyzed, 15% in the amikacin group and 22% in the placebo group developed ventilator-associated pneumonia within 28 days. The amikacin group showed a significant reduction in the incidence of pneumonia with a difference in restricted mean survival time of 1.5 days (P=0.004). Furthermore, the amikacin group had fewer infection-related ventilator complications compared to the placebo group. The research concludes that a 3-day course of inhaled amikacin can decrease the occurrence of ventilator-associated pneumonia in patients ventilated for at least three days.
Based on the AMIKINHAL trial, will you consider using inhaled amikacin for the prevention of VAP?
0%Yes
0%No
0%Probably
Noor Shah
Nov 02, 2023
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I believe that it will be effective as mentioned especially pseudomonas and gram negative rods organisms. 👍
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A Large-Scale Multicenter Retrospective Study on Nephrotoxicity Associated With Empiric Broad-Spectrum Antibiotics in Critically Ill Patients
What is the most common empiric broad-spectrum antibiotic regimen you prescribe in the ICU?
0%Vancomycin + meropenem
0%Vancomycin + cefepime
0%Vancomycin + piperacillin/tazobactam
In this retrospective cohort study, researchers investigated the association between commonly prescribed empiric antibiotics on ICU admission and the risk of acute kidney injury (AKI). The study included 35,654 patients who received either vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. AKI was defined based on the Kidney Disease: Improving Global Outcomes stage 2 or 3 criteria using serum creatinine levels.
The results indicated that vancomycin and piperacillin-tazobactam were associated with a higher risk of AKI and initiation of dialysis compared to both vancomycin and cefepime and vancomycin and meropenem. The odds of AKI were particularly significant in patients without renal insufficiency who received a longer duration of vancomycin and piperacillin-tazobactam therapy compared to vancomycin and meropenem therapy.
The urgent need for effective antibiotics against carbapenem-resistant Acinetobacter baumannii–calcoaceticus complex (ABC) infections led to a phase 3 randomized controlled trial comparing the efficacy and safety of sulbactam–durlobactam versus colistin. The trial involved adults with confirmed ABC-related infections, such as hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, ventilated pneumonia, or bloodstream infections. Patients received either sulbactam–durlobactam or colistin, in combination with imipenem–cilastatin, as background therapy for 7-14 days.
The primary efficacy endpoint was 28-day all-cause mortality in patients with confirmed carbapenem-resistant ABC. The study concluded that sulbactam–durlobactam was non-inferior to colistin (28-day all-cause mortality of 19% versus 20%). Additionally, sulbactam–durlobactam showed a significantly lower incidence of nephrotoxicity compared to colistin. The trial demonstrated that sulbactam–durlobactam could…
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This used single ceftriaxone dose 2g within 12 hours of intubation. It targets eliminating colonisation in orotracheal tree to decrease VAP incidence in pt with high risk for aspiration(stroke, TBI, ICH, SAH)
. It shows less early VAP,less ventilated days, fewer ICU days, less abx usage, fewer Hopitalisation days, delayed VAP onset in ceftriaxone arm, and only two pt showed ESBL in rectal swab upon discharge in ceftriaxonearm.
The microbiological showed majority of polymicrobial yield
They included GCS 3 - 12 (majority were 4 - 8)
Thanks for sharing, Dr. Mazen