Optimal timing for initiating antibiotic therapy in suspected non-severe ventilator associated pneumonia in intensive care units: An ESICM endorsed international survey - OPTI-VAP survey.

BACKGROUND

Ventilator-associated pneumonia (VAP) is a major ICU concern. Current guidelines recommend immediate empirical antibiotic therapy, yet this approach carries substantial ecological risks. The OPTI-VAP study aimed to assess clinicians' decision-making strategies regarding the timing of antibiotic therapy initiation in suspected non-severe VAP.

METHODS

The OPTI-VAP study was an international web-based survey endorsed by the European Society of Intensive Care Medicine.

RESULTS

A total of 163 physicians from 142 centers in 27 countries responded, predominantly from France (47.8%) and India (20.9%). A substantial 62.6% of respondents systematically initiated immediate empirical antibiotic therapy for suspected non-severe VAP. Performing a bronchoalveolar lavage (OR 5.0; 95% CI [1.46-17.06]; p = 0.01) was associated with a strategy of systematically initiating immediate and empirical antibiotic therapy, while the systematic availability of direct examination (Gram stain) results (OR 0.3; 95% CI [0.08-0.98]; p = 0.04) was associated with a delayed strategy. The main justifications for immediate and empirical therapy were worsening gas exchange and pulmonary infiltrates on imaging.

CONCLUSIONS

The observed preference for immediate therapy aligns with current guidelines, likely driven by concerns about adverse clinical complications. However, significant practice disparities were evident, influenced by diagnostic resource availability and local workflows. Future randomized controlled trials are needed to optimize the timing of antibiotic initiation in suspected non-severe VAP.