PT  - JOURNAL ARTICLE
AU  - C. M. Luna
AU  - P. Aruj
AU  - M. S. Niederman
AU  - J. Garzón
AU  - D. Violi
AU  - A. Prignoni
AU  - F. Ríos
AU  - S. Baquero
AU  - S. Gando
ED  - ,
TI  - Appropriateness and delay to initiate therapy in ventilator-associated pneumonia
AID  - 10.1183/09031936.06.00049105
DP  - 2006 Jan 01
TA  - European Respiratory Journal
PG  - 158--164
VI  - 27
IP  - 1
4099  - http://erj.ersjournals.com/content/27/1/158.short
4100  - http://erj.ersjournals.com/content/27/1/158.full
SO  - Eur Respir J2006 Jan 01; 27
AB  - Inappropriate therapy (IT) and delayed initiation of appropriate therapy (DIAT) result in inadequate therapy in patients with ventilator-associated pneumonia (VAP). The aim of the current study was to assess the impact of DIAT in VAP. A total of 76 mechanically ventilated patients with bacteriologically confirmed VAP were prospectively evaluated in the intensive care unit of six hospitals in Buenos Aires, Argentina. Appropriate therapy was defined as coverage of all the identified pathogens by the antimicrobial therapy administered at the time of VAP clinical diagnosis. The clinical pulmonary infection score was measured during the 3 days before, at the onset and during the days which followed the onset of VAP. A total of 24 patients received adequate therapy; mortality was 29.2%. The remaining 52 patients received either IT (n = 16) or DIAT (n = 36); the mortality was 63.5% combined, and 75.0 and 58.3% for IT and DIAT, respectively (statistically significant compared with adequate therapy). Inappropriate therapy and delayed initiation of appropriate therapy increased the mortality of ventilator-associated pneumonia. Patients with inappropriate therapy and/or delayed initiation of appropriate therapy had a more gradual increase in clinical pulmonary infection score than those receiving adequate therapy, and this increase was found to occur prior to the time of the clinical diagnosis. In conclusion, these findings might provide the rationale for a trial of earlier initiation of therapy, based on clinical grounds in an effort to improve the outcome of patients with ventilator-associated pneumonia.