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The relevance of a short course of antibiotic prophylaxis for the prevention of ventilator assocaited pneumonia (VAP) in trauma patients, and its impact on bacterial ecology, remains to be clarified.
Antibiotics are often administered in the pre-hospital phase, usually in cases to traumatic lesions with high risk of secondary infection (open fractures, deteriorating wounds, etc.). If there is a potential benefit of such antibiotic prophylaxis on the risk of surgical site infection, there could also be a benefit on the risk of developing pulmonary infections. Recent data have shown a reduction in the risk of early-onset VAP in cerebrovascular patients with a strategy of very early administration of antibiotic prophylaxis (PROPHYVAP study(1)), as well as in patients taken into intensive care following cardiac arrest (ANTHARTIC study(2)). The aim of the study is to evaluate the impact of early systemic antibiotic prophylaxis in trauma patients on the incidence of early VAP during the ICU stay.
VAP is the most frequent infectious complication in the Intensive Care Units (ICU), with a higher incidence in trauma patients.
Individually, the development of VAP prolongs the duration of mechanical ventilation and in-hospital lenghts of stay, and is associated with additional costs. Collectively, VAP is responsible for around half of all antibiotic consumption in the ICU, with ecological consequences through the emergence of bacterial resistance. Numerous studies and recommendations have been published on the prevention of VAPs. According to current recommendations, this prevention is based on a standardized multimodal approach, including systematic digestive decontamination (SDD) combining an enteral topical antiseptic and systemic antibiotic prophylaxis for less than 5 days to reduce mortality. However, the application of SDD remains limited, and few recent studies have focused on trauma patients. Recently, several studies and meta analysis showed a patential benefit of a single short course of systemic antibiotics (not full SDD) on the risk of subsequent VAP, especially in brain injured patients. The value of short-term antibiotic prophylaxis in trauma patients therefore remains to be documented. The aim of this study is to evaluate the impact of early antibiotic prophylaxis on the risk of VAP in a population of severe trauma patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early antibiotic prophylaxis group | Group will consist of patients meeting the inclusion criteria and :
| ||
| Control group | The group will be made up of patients meeting the inclusion criteria and : - in whom no systemic antibiotic prophylaxis (apart from any intraoperative antibiotic prophylaxis) was administered during the first 72 hours after the start of medical care |
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| Measure | Description | Time Frame |
|---|---|---|
| early onset ventilator associated pneumonia (VAP) | Incidence of early onset VAP (≤ 7 days after mechanical ventilation) | 28 days after ICU admission |
| Measure | Description | Time Frame |
|---|---|---|
| incidence of VAP | Incidence of VAP, whatever the dely of occurrence | 28 days after ICU admission |
| Incidence of late onset VAP | Incidence of late onset VAP (>7 days after mecahnical ventilation) |
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Inclusion Criteria:
Exclusion Criteria:
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Adult trauma patients placed on mechanical ventilation during the first 24 hours of management, and for a duration of at least 48 hours
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| Name | Affiliation | Role |
|---|---|---|
| Arnaud Foucrier, MD | Assistance Publique - Hôpitaux de Paris | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hopital Beaujon | Clichy | 92110 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39945862 | Result | Dahms K, Ansems K, Dormann J, Steinfeld E, Janka H, Metzendorf MI, Breuer T, Benstoem C. Effectiveness of antibiotic prophylaxis in polytrauma patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2025 Feb 13;51(1):105. doi: 10.1007/s00068-025-02789-8. | |
| 39490972 | Result | Hadley-Brown K, Hailstone L, Devane R, Chan T, Devaux A, Davis JS, Hammond N, Li Q, Litton E, Myburgh J, Poole A, Santos J, Seppelt I, Tong SYC, Udy A, Venkatesh B, Young PJ, Delaney AP. Prophylactic Antibiotics in Adults With Acute Brain Injury Who Are Invasively Ventilated in the ICU: A Systematic Review and Meta-Analysis. Chest. 2025 Apr;167(4):1079-1089. doi: 10.1016/j.chest.2024.10.031. Epub 2024 Oct 28. |
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| ID | Term |
|---|---|
| D053717 | Pneumonia, Ventilator-Associated |
| D014947 | Wounds and Injuries |
| D011014 | Pneumonia |
| ID | Term |
|---|---|
| D000077299 | Healthcare-Associated Pneumonia |
| D003428 | Cross Infection |
| D007239 | Infections |
| D012141 | Respiratory Tract Infections |
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| 28 days after ICU admission |
| number of VAP | number of VAP during ICU stay | 28 days after ICU admission |
| Incidence of non-respiratory sepsis | Incidence of non-respiratory sepsis during ICU stay | 28 days after ICU admission |
| Incidence of surgical site infection | Incidence of surgical site infection during ICU stay | 28 days after ICU admission |
| acquisition of multidrug resistant bacteria | acquisition of MDR bacteria during ICU stay | 28 days after ICU admission |
| number of days with mechanical ventilation | Number of days with mechanical ventilation during ICU stay | 28 days after ICU admission |
| length of ICU stay | length of ICU stay | 28 days after ICU admission |
| length of hospital stay | length of hospital stay | 28 days after ICU admission |
| mortality at 28 days | mortality at 28 days | 28 days after ICU admission |
| 38262428 | Result | Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K, Cinotti R, Launey Y, Cottenceau V, Laffon M, Gaillard T, Boisson M, Aleyrat C, Frasca D, Mimoz O; PROPHY-VAP Study Group and the ATLANREA Study Group. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. Lancet Respir Med. 2024 May;12(5):375-385. doi: 10.1016/S2213-2600(23)00471-X. Epub 2024 Jan 20. |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D007049 | Iatrogenic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |