HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chendrasekhar, A. Articles by Hopkins, J. Search for Related Content PubMed Articles by Chendrasekhar, A. Articles by Hopkins, J.

Aerosolized Tobramycin Improves Outcomes in VAP Caused by Enteric Gram-Negative Bacteria in Trauma Patients

Iowa Methodist Medical Center, Des Moines, IA

PURPOSE: Late onset ventilator associated pneumonia (VAP) caused by enteric gram negative bacteria has an attributable mortality ranging from 10-60%. This high mortality rate despite the use of multiple IV antibiotics has led to speculation regarding the inability of IV antibiotics to reach the lungs. Data regarding the use of aerosolized tobramycin (TOBI) in VAP is sparce.

METHODS: We performed a retrospective analysis of a case controlled utilization study of TOBI in VAP caused by enteric gram negative bacteria (microbiologically documented). Trauma patients diagnosed with VAP (by quantitative microbiologic techniques) were pulled from our trauma registry database and a detailed chart review was performed. All patients received either 2 IV antibiotics (Control group-n=25) or 1 IV antibiotic and TOBI (Study group-n=24). Demographic and outcome data were collected and analyzed for statistical significance.

RESULTS: Demographic data (gender, age, injury severity score (ISS), and APACHE-2 score at the time of diagnosis of VAP) were statistically comperable between the control and study groups (Table 1)
Demographic data

Male/Female ratio Age ISS APACHE-2 Control group n=25 20/5 37 ± 18 25.1 ± 9.5 23.7 ± 4.9 Study group n=24 17/7 44 ± 19 22.8 ± 12.3 22.5 ± 5.6

. Outcome data (ICU length of stay, ventilator days, and hospital length of stay) showed significant reductions. Overall survival to hosptal discharge was not signifcantly different (Table 2)
Outcome data

ICU Length of Stay (days) Ventilator days Hospital Length of Stay (days) Survival (%) Control group n=25 16.0 ± 7.1 15.4 ± 6.5 21.8 ± 7.4 80 Study group 11.1 ± 5.4 9.9 ± 3.3 16.3 ± 5.4 91  n=24 *p<0.05 *p<0.05 *p<0.05

CONCLUSIONS: In clinically matched trauma patients with VAP caused by enteric gram negative bacteria the use of aerosolized tobramycin (TOBI) seems to improve clinical outcomes.

CLINICAL IMPLICATIONS: TOBI may be a useful tool in the treatment of VAP caused by enteric gram negative bacteria.

DISCLOSURE: A. Chendrasekhar, CHIRON, discussion of product research or unlabeled uses of product.