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The following is a summary of “Antibiotic definitive treatment in ventilator associated pneumonia caused by AmpC-producing Enterobacterales in critically ill patients: a prospective multicenter observational study,” published in the February 2024 issue of Critical Care by Petit et al.

Researchers launched a retrospective study investigating the efficacy and safety of definitive antimicrobial therapy (AMT) with third-generation cephalosporins (3GCs) or piperacillin for ventilator-associated pneumonia (VAP) caused by wild-type AmpC-producing Enterobacterales (wtAE) in ICU patients, given the current lack of robust evidence and discouragement of this treatment approach.

They involved consecutive patients with VAP caused by Gram-negative bacteria in 20 French ICUs. The primary goal was to evaluate how the choice of definitive antibiotic treatment (piperacillin ± tazobactam (PTZ), 3GCs, or other antibiotics such as fourth-generation cephalosporins (4GCs), carbapenems, quinolones, cotrimoxazole) influenced treatment success by day 7. Also examined infection recurrence as a secondary outcome, considering death as a competing risk.

The results showed  274 patients (February 2021 and June 2022). Enterobacter cloacae were the most prevalent species, accounting for 31% of cases, 28% received PTZ as definitive antibiotic treatment, 16% were prescribed 3GCs, and 56% were categorized under the control group. The success rates by day 7 were similar across the three groups (74% vs. 73% vs. 68%, respectively, P=0.814). At day 28, the probability of recurrence was 31% (95% CI 21–42), 40% (95% CI 26–55), and 21% (95% CI 15–28) for the PTZ, 3GCs, and control groups, respectively (P=0.020). Multivariable analysis revealed that while the choice of definitive antibiotic treatment did not affect clinical success, the use of 3GCs was associated with a higher likelihood of recurrence at day 28 [csHR(95%CI) 10.9 (1.92–61.91)].

They concluded that 3GCs in VAP with wtAE didn’t affect day-7 success but were linked to higher day-28 pneumonia recurrence, with no impact on mortality or ventilation duration.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04820-7