iDIAPASON
Trial question
Is short duration of antibiotic therapy noninferior to prolonged antibiotic therapy in patients with P. aeruginosa ventilator-associated pneumonia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
24.0% female
76.0% male
N = 186
186 patients (45 female, 141 male).
Inclusion criteria: adult patients with P. aeruginosa ventilator-associated pneumonia.
Key exclusion criteria: current antibiotic therapy active on P. aeruginosa for extra-pulmonary infection; chronic pulmonary colonization with P. aeruginosa; immunosuppression.
Interventions
N=88 short-duration therapy (antibiotic treatment for 8 days).
N=98 long-duration therapy (antibiotic treatment for 15 days).
Primary outcome
Composite outcome of death and recurrence in intensive care unit at day 90
35.2%
25.5%
35.2 %
26.4 %
17.6 %
8.8 %
0.0 %
Short-duration
therapy
Long-duration
therapy
Difference not exceeding
non-inferiority
margin ✓
Difference not exceeding non-inferiority margin in composite outcome of death and recurrence in the ICU at day 90 (35.2% vs. 25.5%; AD 9.7%, 90% CI 0 to 21.2).
Secondary outcomes
Borderline significant increase in recurrence in the ICU at day 90 (17% vs. 9.2%; AD 7.9%, 90% CI 0 to 16.8).
No significant difference in duration of mechanical ventilation (22 days vs. 25 days; AD -3 days, 95% CI -9 to 5).
No significant difference in duration of ICU stay (34 days vs. 34 days).
Conclusion
In adult patients with P. aeruginosa ventilator-associated pneumonia, short-duration therapy was noninferior to long-duration therapy with respect to the composite outcome of death and recurrence in the ICU at day 90.
Reference
Adrien Bouglé, Sophie Tuffet, Laura Federici et al. Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med. 2022 Jul;48(7):841-849.
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