Selective digestive decontamination and empirical antimicrobial therapy of late–onset ventilator–associated pneumonia in trauma patients

Objective To assess the appropriateness of empirical antimicrobial therapy in trauma patients treated with selective digestive decontamination (SDD) who developed ventilator-associated pneumonia (VAP). Methods Retrospective study comparing 199 trauma patients receiving SDD and 99 non-trauma patients not receiving SDD hospitalized in a polyvalent intensive care unit (ICU) of a university hospital. Results Early-onset VAP were recorded in 76 (35%) patients. Late-onset VAP occurred in 86 (72%) trauma patients receiving SDD and 56 (56%) non-trauma patients not receiving SDD (P = 0.02). The empirical antimicrobial therapy was appropriate in 108 (91%) trauma patients receiving SDD and 82 (83%) non-trauma patients not receiving SDD (P = 0.1). In the patients who developed late-onset VAP, the empirical antimicrobial therapy was appropriate in 77 (90%) trauma patients receiving SDD and 49 (88%) non-trauma patients not receiving SDD (P = 0.9). De-escalation was performed in 52 (44%) trauma patients receiving SDD and 37 (37%) non-trauma patients not receiving SDD (P = 0.4). Recurrences were observed in 26 (22%) trauma patients receiving SDD and 18 (18%) non-trauma patients not receiving SDD (P = 0.6). These episodes were due to easy-to-treat pathogens in 75 (63%) trauma patients and 33 (33%) non-trauma patients (P = 0.01). Conclusions SDD is not associated with a rise in the rate of inappropriateness of the empirical antimicrobial therapy in trauma patients developing late-onset VAP.