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February 18, 2004

Eight Days vs 15 Days of Antibiotics for Ventilator-Associated Pneumonia—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(7):820. doi:10.1001/jama.291.7.820-b

In Reply: Dr Nicastri is concerned that only one third of the patients initially considered eligible were actually retained for analysis. Patients with early-onset pneumonia (15.4%) were not included because this condition is usually caused by susceptible pathogens that do not require prolonged antibiotic therapy. Patients who did not receive appropriate empirical treatment (6.7%) were ineligible because evaluation of antibiotic duration is very difficult in this setting. Because patients with a Simplified Acute Physiology Score (SAPS II) exceeding 65 have a high risk of death before day 15, their inclusion would have further complicated the analysis. Only patients with extrapulmonary infections, for example, osteomyelitis, that had been diagnosed between days 1 and 3 and that had required prolonged treatment (6.4%) were excluded. Based on mean SAPS at admission/inclusion of 45/45 and 40/39, we consider our samples to comprise critically ill patients. As we stated in our article, our findings cannot readily be extrapolated to other populations.

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