Clinical suspicion of ventilator associated pneumonia in critically ill patients Respiratory Pneumonia
Conditions
Interventions
Patients will undergo bronchoscopy with bronchoalveolar lavage or endotracheal aspirates. Following sampling patients will be randomised again to receive either meropenem and ciprofloxacin or meropene
Sponsors
Queen?s University (Canada)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Adult patients greater than or equal to 16 years old, either sex 2. Greater than 96 hours in the Intensive Care Unit (ICU) 3. Mechanically ventilated (greater than or equal to 48 hours) 4. Develops a clinical suspicion of pneumonia while ventilated
Exclusion criteria
Exclusion criteria: 1. Unstable candidate for bronchoscopy as defined by the bronchoscopist 2. Patients not expected to survive greater than 72 hours or anticipate withdrawing treatments within 72 hours from the point of randomisation 3. Known or suspected history of anaphylaxis to penicillins, cephalosporins, carbapenems, meropenem or ciprofloxacin 4. Women who are pregnant or lactating 5. Patients already infected or colonised (respiratory tract only) with an organism not sensitive to study drugs 6. Patients already infected with pseudomonas species 7. Already on study drugs 8. Immunocompromised (post-organ transplantation, Human Immunodeficiency Virus [HIV], neutropenic [less than 1000 absolute neutrophils], corticosteroids [greater than 20 mg/day of prednisone or equivalent for more than 6 months]) 9. Prior randomisation in this study 10. Enrolment in other interventional study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Mortality at 28 days. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Duration of stay in ICU 2. Adjudicated diagnosis of pneumonia 3. Clinical and microbiological response to treatment 4. Adequacy of initial treatment 5. Emergence of resistant organisms 6. Candida colonization and infection 7. Multiple organ dysfunction 8. Duration of mechanical ventilation 9. Hospital length of stay 10. Antibiotic use and costs of care | — |
Countries
Canada
Outcome results
None listed