Lu et al randomized 40 patients with Pseudomonas ventilator-associated pneumonia in France to receive ceftazidime & amikacin, either intravenously or by nebulizer for 8 days. There were no differences in treatment success or documented superinfection by other bugs. AJRCCM 2011;184:106-115.
Enrollment began when microbiologic VAP was diagnosed (i.e., when BAL/mini-BAL culture results came back) and patients already receiving initial antibiotics active against Pseudomonas were excluded. But most “real world” patients in the U.S. with suspected VAP would likely be treated with initial empiric anti-Pseudomonal coverage, by ATS/IDSA guidelines … so, is this applicable to our patients here in the States?