OPTIMIZATION OF EMPIRICAL ANTIBACTERIAL THERAPY OF VENTILATOR-ASSOCIATED PNEUMONIA, INDUCED BY GRAM-NEGATIVE MULTIRESISTANT STRAINS

Abstract

Introduction: Ventilator-associated pneumonia is one of the most common healthcare associated infections, arising in the ICU. The greatest difficulty is presented by patients, whose infection is caused by gram-negative multidrug-resistant strains. That is why empirical antibacterial therapy of ventilator-associated pneumonia requires optimization and improvement. Aim of study: To compare the effectiveness of two schemes of empirical antibacterial therapy of ventilator-associated pneumonia, based on carbapenems, aminoglycosides and monobactams. Materials and methods: This is randomized controlled monocentral study, which included 64 patients older than 18 years, who have developed ventilator- associated pneumonia during long-term mechanical ventilation. Results: The use of combination of meropenem and aztreonam as an empirical antibiotic therapy of ventilator-associated pneumonia was accompanied by a significant increase of oxygenation indexes, effective purification of sputum from microorganisms, decrement of resistance and superinfection development in comparing with patients with traditional scheme empiric antibacterial therapy. The recommended scheme is also safe in nephrotoxicity context. Conclusion: The use as an empirical antibacterial therapy of ventilator-associated pneumonia the combination of meropenem and aztreonam was accompanied by significant decrement of length of mechanical ventilation and significant reduction of ICU-stay. The mortality levels were also less in investigation group compared with the group with traditional scheme of empirical antibacterial therapy.