TREATMENT OF VENTILATOR-ASSOCIATED PNEUMONIA WITH PIPERACILLIN-TAZOBACTAM AMIKACIN VERSUS CEFTAZIDIME/AMIKACIN - A MULTICENTER, RANDOMIZED CONTROLLED TRIAL/

In a randomized trial conducted in 27 intensive care units, we compare d the clinical efficacy and safety of piperacillin-tazobactam (TAZ; 4 g/0.5 g q.i.d.) and of ceftazidime (CAZ; 1 g q.i.d,), both combined wi th amikacin (7.5 mg/kg b.i.d.), as therapy for ventilator-associated p neumonia (VAP; acquired after greater than or equal to 48 hours of mec hanical ventilation). VAP was diagnosed with use of protected samples and quantitative cultures, and outcome was assessed blindly from treat ment. Of 204 patients suspected of having VAP and randomized to a trea tment arm of the study, 127 (64%) had bacteriologically confirmed infe ctions, of which 37% were polymicrobial and 32% involved Pseudomonas a eruginosa; 115 patients (51 TAZ and 64 CAZ recipients) remained evalua ble as per protocol. Clinical/bacteriologic cure rates (TAZ vs, CAZ, 5 1% vs. 36%; 95% confidence interval of difference, -0.2% to 30.2%), an d 28-day mortality rates (16% vs. 20%) were similar; however, fewer ba cteriologic failures occurred with TAZ (33% vs. 51%; P=.05). We conclu de that the two regimens were of equivalent clinical efficacy in thera py for confirmed VAP.