الفهرس 
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Abstract
P
atients in the intensive care unit (ICU) are at risk for dying not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients. Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator-associated pneumonia (VAP). Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 h after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside examination, radiographic examination, and microbiologic analysis of respiratory secretions.
This study aimed to compare the Efficacy and nephrotoxicity of extended versus intermittent infusion of beta-lactams for the treatment of ventilator associated pneumonia.
This Retrospective study has been held in Intensive Care Units in Ain Shams University Hospitals on critically ill patients with ventilator associated pneumonia after applying exclusion criteria, in the period from April 2023 till December 2023. After approval of Ethical & Research committee of Ain Shams University. Our study population was comprised of two study groups, the extended infusion group (n=40) and intermittent infusion group (n=40).
The current study results compared between the extended infusion group and intermittent infusion group based on APACHE II and SOFA scores, no statistically significant differences were observed in either score. For the APACHE II score, the mean score was 23.20±7.08 in the extended infusion group and 25.63±7.00 in the intermittent infusion group, with a p-value of 0.128. Similarly, for the SOFA score, the mean score was 10.35±2.52 in the extended infusion group and 10.93±1.97 in the intermittent infusion group, with a p-value of 0.258. These findings indicate that the severity of illness, as assessed by these scoring systems, was comparable between the two groups at baseline.
The current study results compared the extended infusion group with the intermittent infusion group based on the Clinical Pulmonary Infection Score (CPIS), no statistically significant differences were found. Therefore, any disparities in treatment outcomes between extended and intermittent infusion methods cannot be attributed to differences in the initial severity of pulmonary infection.
The current study results compared between the extended infusion group and the intermittent infusion group based on the starting creatinine clearance (CrCl), no statistically significant differences were found. This suggests that the efficacy and nephrotoxicity of the two infusion methods should be assessed independently of starting renal function.
The current study results compared the extended infusion group to the intermittent infusion group based on the time to white cell count normalization, statistically significant differences were observed. The mean time to white cell count normalization was 7.44±2.06 days in the extended infusion group and 10.19±2.25 days in the intermittent infusion group, with a p-value of 0.000, indicating a high level of significance. The range of time to normalization was 4-12 days in the extended infusion group and 5-16 days in the intermittent infusion group. These findings suggest that patients in the extended infusion group achieved normalization of white cell counts significantly faster than those in the intermittent infusion group. This implies that extended infusion of beta-lactam antibiotics may be more effective in resolving the underlying infection, leading to a quicker recovery of white cell counts.
The current study results compared the extended infusion group to the intermittent infusion group based on the time to C-reactive protein (CRP) normalization, statistically significant differences were observed. The mean time to CRP normalization was 8.27±2.05 days in the extended infusion group and 11.53±2.93 days in the intermittent infusion group, indicating a high level of significance. The range of time to normalization was 5-14 days in the extended infusion group and 6-16 days in the intermittent infusion group. These findings suggest that patients in the extended infusion group achieved normalization of CRP levels significantly faster than those in the intermittent infusion group. This indicates that extended infusion of beta-lactam antibiotics may lead to a more rapid resolution of inflammation, reflecting a potentially quicker response to treatment and improvement in the underlying infection.
The current study results compared between the extended infusion group and the intermittent infusion group based on microbiologic characteristics, no statistically significant differences were observed in the prevalence of gram-negative or gram-positive microorganisms. In the extended infusion group, 95.0% of cases were associated with gram-negative organisms, while 5.0% were associated with gram-positive organisms. Similarly, in the intermittent infusion group, 85.0% of cases were associated with gram-negative organisms, and 15.0% were associated with gram-positive organisms. The p-value for the comparison of gram-negative prevalence was 0.136, indicating no statistically significant difference between the two groups. These findings suggest that the distribution of microbiologic characteristics, specifically the prevalence of gram-negative and gram-positive organisms, was similar between the extended and intermittent infusion groups. Therefore, any observed differences in treatment outcomes between the two infusion methods are less likely to be influenced by variations in microbiologic characteristics.
The current study results compared the extended infusion group to the intermittent infusion group based on ventilator days, statistically significant differences were observed. The mean ventilator days were 6.85±1.41 days in the extended infusion group and 8.88±2.27 days in the intermittent infusion group, with a p-value of 0.002, indicating statistical significance. The range of ventilator days was 4-13 days in the extended infusion group and 4-15 days in the intermittent infusion group. This implies that extended infusion of beta-lactam antibiotics may contribute to a quicker resolution of ventilator-associated pneumonia, leading to a shorter requirement for mechanical ventilation.
The current study results compared between the extended infusion group and the intermittent infusion group based on ICU survival, statistically significant differences were observed. In the extended infusion group, 75.0% of patients survived their ICU stay, while in the intermittent infusion group, 52.5% of patients survived. This implies that extended infusion of beta-lactam antibiotics may contribute to improved ICU survival outcomes.
The current study results compared between the extended infusion group and the intermittent infusion group based on bacterial eradication, statistically significant differences were observed. In the extended infusion group, 70.0% of patients achieved bacterial eradication, whereas in the intermittent infusion group, only 45.0% achieved bacterial eradication. The p-value for this comparison was 0.024, indicating statistical significance. This implies that extended infusion of beta-lactam antibiotics may be more effective in eliminating bacteria associated with ventilator-associated pneumonia.