PROPHY-VAP Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial - The Lancet Respiratory Medicine | Notion

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00471-X/fulltext#:ü:text=In patients with acute brain injury%2C a single ceftriaxone dose,injury who require mechanical ventilation

Background:

Ventilator-associated pneumonia (VAP) is a leading cause of health-care-associated infections in critically ill patients, prolonging mechanical ventilation, increasing ICU stay, and raising hospital costs.
Patients with acute brain injury are at heightened risk of developing early VAP, with incidence reported in the literature ranging from 20% to 71% in severe trauma and from 28% to 76% in stroke patients.

Study Design:

PROPHY-VAP was a multicentre, randomised, double-blind, placebo-controlled, superiority trial conducted in nine intensive care units in eight French university hospitals.
Adult patients with acute brain injury requiring mechanical ventilation for at least 48 hours were randomly assigned to receive intravenous ceftriaxone 2 g or placebo within 12 hours following tracheal intubation.

Outcomes:

From a total of 345 randomly assigned patients, 319 were included in the analysis, with 162 in the ceftriaxone group and 157 in the placebo group.
The incidence of early VAP was lower in the ceftriaxone group than in the placebo group (14% vs 32%), with no microbiological impact and no adverse effects attributable to ceftriaxone.

Interpretation:

A single ceftriaxone dose decreased the risk of early VAP in patients with acute brain injury, suggesting its inclusion in all prevention bundles for VAP in such patients.
This preventive measure alone could be applied in all patients with acute brain injury in the ICU, potentially reducing secondary cerebral insults and improving patient flow.

Implications:

The PROPHY-VAP trial provides evidence to support the modification of VAP prevention recommendations, with potential application to all patients with acute brain injury in the ICU.
Reducing the risk of VAP could lead to decreased secondary cerebral insults, improved patient flow, and antibiotic savings.

Conclusion:

A single ceftriaxone dose has been shown to be effective in decreasing the risk of early VAP in patients with acute brain injury, with potential implications for improving patient outcomes and resource utilization.

PROPHY-VAP Trial:

PROPHY-VAP trial demonstrated that a single dose of ceftriaxone reduced antibiotic consumption in patients with severe brain injury.