Arles

Ventilator-associated pneumonia (VAP) is a common and serious infection in intensive care units, often leading to prolonged mechanical ventilation and excessive antibiotic use. This trial evaluates two strategies for starting antibiotic therapy in patients with suspected non-severe VAP: immediate antibiotic treatment after sampling versus waiting for microbiological confirmation before starting treatment. The study aims to balance the risks of unnecessary antibiotic exposure against the dangers of delaying therapy in infected patients, considering concerns about antibiotic resistance and patient outcomes. Participants are randomly assigned to one of two groups. The control group receives immediate empiric antibiotic therapy within one hour of randomization, based on clinical judgment and local protocols; treatment is stopped if respiratory samples are negative or continued for seven days if VAP is confirmed. The conservative strategy group waits for respiratory sample culture and/or PCR results before starting antibiotics; if results are negative, no antibiotics are given, and if positive, treatment is started promptly and continued for seven days without waiting for susceptibility testing. Throughout the study, participants are monitored for death or continued use of invasive mechanical ventilation up to 28 days. Researchers record the proportion of patients who die or remain on ventilation at 28 days as the primary outcome. The study involves patients who have been mechanically ventilated for more than 48 hours and meet specific clinical criteria for suspected VAP without signs of severe illness, with informed consent obtained from patients or their representatives.