Assisted ventilation pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation (mechanical ventilation). The number of reports of PWA caused by resistant microorganisms is increasing.

In this prospective, randomized, controlled study, in which 290 patients participated, the tactics of early discontinuation of antibiotic therapy and traditional treatment of patients with VAP were compared. We took into account age, sex, race, the cause of mechanical ventilation, the ratio of RaO2 to the fraction of breathing oxygen (FiO2), the APACHE II score, the presence of chronic obstructive pulmonary disease and treatment received in connection with this, HIV infection, congestive heart failure, malignant neoplasm immunosuppression. In all patients with suspected PWA, antibiotic therapy started with a combination of:

The researchers chose cefepime + cirofloxacin or cefepime + gentamicin, because they were effective in more than 90% of cases on the basis of antibiograms.

Randomization was carried out in 2 groups: patients whose antibiotic therapy was interrupted under the conditions listed below (n = 150) and the group receiving therapy at the discretion of the attending physician (traditional therapy group) (n = 140).

The mean age of the patients was 59.9 ± 17.8 years; the male / female ratio was 1: 1. The average APACHE II score was 23.0 ± 9.2 and the CPIS (clinical pulmonary infection score) was 7.1 ± 0.9. The initial recommended regimen for VAP was used in 81.3% of patients in the main group and 83.6% of the control group (p = 0.617). The proportion of patients with a non-infectious etiology of infiltrate was 8.7% and 6.4%, respectively. The duration of antibiotic therapy was shorter in the main group (6.0 ± 4.9 days) compared to the control group (8.0 ± 5.6 days, p = 0.001). Mortality was 32.0% (n = 48) and 37.1% (n = 37) (p = 0.357), respectively. The length of stay was somewhat shorter in the main group (6.8 ± 6.1 days) than in the control group (7.0 ± 7.3 days).

On the basis of the results obtained, it was concluded that stopping antibiotic therapy in the presence of the above signs leads to a reduction in the duration of the course by 2 days without a statistically significant increase in mortality and the duration of stay in ICU. In patients suspected of VAP, during clinical monitoring of a response to treatment, early cessation of antibacterial therapy is safe. However, more studies are needed to confirm the feasibility and safety of this therapeutic tactic.