Lung ultrasound may guide about duration of Intibiotic therapy in ventilator-associated pneumonia

In most cases, ventilator-associated pneumonia is caused by prolonged mechanical ventilation, intensive care unit (ICU) stays, and increasing antibiotic use (VAP). Timely initiation of antibiotic treatment is the cornerstone of the management of VAP caused by bacterial infection. However, prolonged antibiotic treatment increases the prevalence of bacterial resistance, cost load, and severe medication effects. Procalcitonin (PCT) may be useful in deciding whether to initiate or discontinue antibiotic medication.

A recently published research investigated the usefulness of lung ultrasound in counseling patients with VAP to discontinue antibiotic treatment.

62 VAP patients were included in a prospective, blinded cohort trial from October 2020 to September 2021. Antibiotics were started, the procalcitonin (PCT) level and clinical pulmonary infection score were determined, and a lung ultrasound (US) was conducted on day 1 and again on day 7; these procedures were repeated on day 7. If the PCT level was less than 0.25 g/mL on day 7, it was advised that antibiotics be discontinued.

A score for lung reaeration was reported. In 40 patients, antibiotics were withdrawn based on PCT levels. The computed CT results for VAP have all improved. The ultrasonography reaeration score had a negative connection with the PCT on day 7 that was statistically significant (-0.718, P 0.001). A US score cutoff of 5 had a sensitivity of 92.5 percent, a specificity of 95.5 percent, a positive predictive value of 97.4 percent, and a negative predictive value of 87.5 percent for identifying a low PCT score on day 7.

The results of the current research indicate that lung ultrasound is a reliable noninvasive approach for discontinuing antibiotic treatment in VAP patients. This choice is very important and requires exact scheduling and well-defined milestones. A shorter course of antibiotic therapy and early cessation of antibiotics may help minimize needless expenses and antibiotic exposure and resistance, as well as cut antibiotic costs. In a research, it was determined that the combination of lung US and PCT is superior to the use of lung US, PCT, CPIS, and other inflammatory biomarkers alone for diagnosing pneumonia in ventilated patients with symptoms. In the present investigation, correlation between US and PCT levels on day 7 was statistically significant (r = 0.718, P = 0.000).

Reference –

Ammar, Mona A.,; Hilal, Amr; Abdalla, Waleed The role of lung ultrasound in procalcitonin-guided antibiotic discontinuation in ventilator-associated pneumonia, Indian Journal of Anaesthesia: June 2022 - Volume 66 - Issue 6 - p 431-435 doi: 10.4103/ija.ija_989_21