The Optimal Duration of Antibiotic Treatment for Hospital-acquired Pneumonia: A Comparative Study between the Two-antibiotic Discontinuation Policies
Chaicharn Pothirat*, Juthamas Inchai, Ratapum ChampunotChiang Mai University, Chiang Mai, Thailand
บทคัดย่อ
Purpose: To compare the duration of antibiotic treatment for hospital-acquired pneumonia between the two-antibiotic discontinuation policies.
Methods: A prospective, randomized controlled trial was conducted in the medical ICU, Chiang Mai University hospital(CMUH).The hospital-acquired pneumonia patients who revealed clinical response within the first week of antibiotic treatment were randomly received one of the two-antibiotic discontinuation policies. One policy is to discontinue antibiotic as soon as the patient can reach our ‘CMUH-Clinical Point of Cure(CMUH-CPC)’ criteria (intervention group) whereas the other is to discontinue antibiotic by the physician’s judgment (control group). Those who could meet CMUH-CPC criteria within 14 days in each group were defined as evaluable patients.
Results: There were 69/82 (84.1%) randomized patients,intervention group (n=36) and control group (n=33),could reach CMUH-CPC criteria and be evaluated. The baseline demographic parameters including age, sex (male/female), comorbidity, simplified acute physiology score version II (SAPS II), clinical pulmonary infection score (CPIS), sequential organ failure assessment (SOFA) score and the major non-fermentative gram negative pathogens (P. aeruginosaand A. baumannii) were not significantly different between both groups (65.6±20.1 vs 65.4±15.8, 21/15 vs. 17/16, 77.8% vs. 75.8%, 39.9±13.5 vs. 42.6±10.6, 7.8±1.2 vs. 7.5±1.1, 4.7±3.2 vs. 5.5±2.8 and 81.9% vs.63.3%, respectively). The duration of antibiotic treatment in the intervention group was significantly shorter (8.7±2.8 vs. 14.5±2.6 day, p <0.001) and the antibiotic cost was also significantly lower ($1,098.4±393.3 vs. $1,498.9±667.3, p=0.007) than the control group whereas the relapse rate, other nosocomial infection rate, day-28 mortality rate, hospital mortality and hospital length of stay were not significantly different between both groups (16.1% vs. 6.7%,17.6% vs. 25.0%, 13.9% vs. 18.2%, 24.2% vs. 27.6%, and 39.5±18.7 vs. 36.9±22.8 days, respectively).
Conclusion: The optimal antibiotic treatment duration for hospital-acquired pneumonia could be shortening safely and cost-efficiently by using the CMUH-CPC criteria.
Clinical implications: The CMUH-CPC criteria can be applied for antibiotic discontinuation in the hospital-acquired pneumonia patients who revealed clinical response within the first week and could reach the criteria within 2 weeks of antibiotic treatment regardless of pathogens.
