A Comparison of the Efficiency of Treatment With Imipenem/Cilastatin, Ceftazidime and Piperacillin/Tazobactam in Patients With Ventilator-Associated Pneumonia

Objective: To compare the efficacy of three separate antibiotics (ceftazidime, imipenem/cilastatin and piperacillin/tazobactam) as an early empiric (de-escalating) antibiotic therapy in patients with ventilator-associated pneumonia (VAP).

Materials and Methods: Forty-nine patients with VAP caused by Gram (-) organisms, were given ceftazidime (13 patients), imipe­nem/cilastatin (19 patients) or piperacillin/tazobactam (17 pati­ents) as an early empiric therapy. By the end of the treatment the adequacy of the antibiotic treatment was evaluated clinically (cu­red, partly cured, failure), bacteriologically (eradication, persisten­ce of the pathogen, new infection) and also as number of days free of mechanical ventilation and of application of antibiotic agents in the three groups.

Results: There were no differences as to sex, age, diagnosis, seve­rity, complications (sepsis, septic shock, multiorgan insufficiency) or pathogens causing VAP among the three groups of patients. Treatment with imipenem/cilastatin resulted in the highest percen­tage of pathogen eradication, the highest number of days without mechanical ventilation and of application of antibiotics and the highest chance of favourable outcome (p<0.05), thus imipenem/ci­lastatin was found to be superior as an initial therapeutic agent to the other two antibiotics.

Conclusions: Early empiric antibiotic therapy is the prerequisite of a successful treatment in VAP. In this study, imipenem/cilastatin was found to be the antibiotic of choice as an initial antibiotic. Treatment with imipenem/cilastatin was found to lead to better clinical and mic­robiological results compared to ceftazidime and piperacillin/tazobac­tam. Treatment with this antibiotic also proved to be more cost-effec­tive because of the shorter duration of treatment and of mechanical ventilation.