Ventilator Associated Pneumonia ( VAP)
Conditions
Keywords
trauma, antibioprophylaxis, pneumonia, ventilator associated pneumonia
Brief summary
The relevance of a short course of antibiotic prophylaxis for the prevention of ventilator assocaited pneumonia (VAP) in trauma patients, and its impact on bacterial ecology, remains to be clarified. Antibiotics are often administered in the pre-hospital phase, usually in cases to traumatic lesions with high risk of secondary infection (open fractures, deteriorating wounds, etc.). If there is a potential benefit of such antibiotic prophylaxis on the risk of surgical site infection, there could also be a benefit on the risk of developing pulmonary infections. Recent data have shown a reduction in the risk of early-onset VAP in cerebrovascular patients with a strategy of very early administration of antibiotic prophylaxis (PROPHYVAP study(1)), as well as in patients taken into intensive care following cardiac arrest (ANTHARTIC study(2)). The aim of the study is to evaluate the impact of early systemic antibiotic prophylaxis in trauma patients on the incidence of early VAP during the ICU stay.
Detailed description
VAP is the most frequent infectious complication in the Intensive Care Units (ICU), with a higher incidence in trauma patients. Individually, the development of VAP prolongs the duration of mechanical ventilation and in-hospital lenghts of stay, and is associated with additional costs. Collectively, VAP is responsible for around half of all antibiotic consumption in the ICU, with ecological consequences through the emergence of bacterial resistance. Numerous studies and recommendations have been published on the prevention of VAPs. According to current recommendations, this prevention is based on a standardized multimodal approach, including systematic digestive decontamination (SDD) combining an enteral topical antiseptic and systemic antibiotic prophylaxis for less than 5 days to reduce mortality. However, the application of SDD remains limited, and few recent studies have focused on trauma patients. Recently, several studies and meta analysis showed a patential benefit of a single short course of systemic antibiotics (not full SDD) on the risk of subsequent VAP, especially in brain injured patients. The value of short-term antibiotic prophylaxis in trauma patients therefore remains to be documented. The aim of this study is to evaluate the impact of early antibiotic prophylaxis on the risk of VAP in a population of severe trauma patients.
Interventions
None listed
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient * Trauma patient: admitted between 01/01/2021 and 31/12/2023 for suspected severe trauma (included in TraumaBase® ) * Put on mechanical ventilation during the first 24 hours following the start of medical care (including pre-hospital care) * Patient on MV for at least 48 consecutive hours during intensive care stay * Patient does not object to the use of his/her data for this research
Exclusion criteria
* Patient under full selective digestive decontamination protocol * Early inhaled antibiotic prophylaxis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| early onset ventilator associated pneumonia (VAP) | 28 days after ICU admission | Incidence of early onset VAP (≤ 7 days after mechanical ventilation) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| length of ICU stay | 28 days after ICU admission | length of ICU stay |
| length of hospital stay | 28 days after ICU admission | length of hospital stay |
| mortality at 28 days | 28 days after ICU admission | mortality at 28 days |
| acquisition of multidrug resistant bacteria | 28 days after ICU admission | acquisition of MDR bacteria during ICU stay |
| number of days with mechanical ventilation | 28 days after ICU admission | Number of days with mechanical ventilation during ICU stay |
| Incidence of late onset VAP | 28 days after ICU admission | Incidence of late onset VAP (\>7 days after mecahnical ventilation) |
| number of VAP | 28 days after ICU admission | number of VAP during ICU stay |
| Incidence of non-respiratory sepsis | 28 days after ICU admission | Incidence of non-respiratory sepsis during ICU stay |
| Incidence of surgical site infection | 28 days after ICU admission | Incidence of surgical site infection during ICU stay |
| incidence of VAP | 28 days after ICU admission | Incidence of VAP, whatever the dely of occurrence |
Countries
France
Outcome results
None listed