• Harriet Sommer, Jean-François Timsit, Maja von Cube, Martin Schumacher, Michael Darmon, Carole Schwebel, Stéphane Ruckly, Martin Wolkewitz, and COMBACTE-MAGNET Consortium.
• Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
• Crit. Care Med. 2018 Oct 1; 46 (10): 1643-1648.

ObjectivesWe aim to examine the effect of early adequate treatment in comparison with inadequate or delayed treatment on being extubated or discharged alive over time, in patients with Pseudomonas aeruginosa-related ventilator-associated pneumonia.DesignRetrospective analyses of a prospective observational multicenter cohort study.SettingICU.PatientsPatients of the French prospective database (OUTCOMEREA) were included if they acquired a ventilator-associated pneumonia due to P. aeruginosa between 1997 and 2014 and were mechanically ventilated for more than 48 hours.InterventionsEarly adequate treatment in comparison with inadequate or delayed adequate treatment.Measurements And Main ResultsMultistate models were applied to estimate the time-dependent probability of being extubated or discharged alive, and separate Cox regression analyses were used to assess the treatment effect on all important events that influence the outcome of interest. A propensity score-adjusted innovative regression technique was used for a combined and comprehensive patient-relevant summary effect measure. No evidence was found for a difference between adequate and inadequate or delayed treatment on being extubated or discharged alive. However, for all patients, the probability of being extubated or discharged alive remains low and does not exceed 50% even 40 days after a P. aeruginosa-related ventilator-associated pneumonia.ConclusionsEarly adequate treatment does not seem to be associated with an improved prognosis. Its potential benefit requires further investigation in larger observational studies.

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