Intensive Care Med (2004) 30:1327–1333 DOI 10.1007/s00134-004-2292-7 ORIGINAL Christophe Clec’h Jean-François Timsit Arnaud De Lassence Elie Azoulay Corinne Alberti Maite Garrouste-Orgeas Bruno Mourvilier Gilles Troche Muriel Tafflet Olivier Tuil Yves Cohen Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity Received: 15 December 2003 Accepted: 25 March 2004 Published online: 9 June 2004 # Springer-Verlag 2004 Outcomerea is supported by nonexclusive educational grants from Aventis Pharma, France, Wyeth-Lederle and Centre National de la Recherche Scientifique (C.N.R.S) Electronic Supplementary Material Supplementary material is available in the online version of this article at http:// dx.doi.org/10.1007/s00134-004-2292-7 C. Clec’h · O. Tuil · Y. Cohen ( ) ) Medical and Surgical ICU, RØanimation MØdico-Chirurgicale, Hôpital Avicenne, 125 Route de Stalingrad, 93009 Bobigny, France e-mail: yves.cohen@outcomerea.org Tel.: +33-1-48955249 Fax: +33-1-48955090 J.-F. Timsit · B. Mourvilier Medical ICU, Hôpital Bichat Claude Bernard, Paris, France A. D. Lassence Medical ICU, Hôpital Louis Mourier, Colombes, France E. Azoulay Medical ICU, Hôpital Saint Louis, Paris, France J.-F. Timsit · C. Alberti Biostatistic Department, Hopital Saint Louis, Paris, France M. Garrouste-Orgeas Medical-Surgical ICU, Hôpital Saint Joseph, Paris, France G. Troche Surgical ICU, Hôpital Antoine BØclre, Clamart, France M. Tafflet Biostatistic Department OutcomerØa Abstract Objective: To test the hy- pothesis that the outcome of patients with ventilator-associated pneumonia (VAP) depends on both their baseline severity at VAP onset and the ade- quacy of empirical antibiotic therapy. Design and setting: Prospective clinical study in six intensive care units in Paris, France. Patients: One hundred and forty-two patients with VAP after  48 h of mechanical ventilation. Measurements and results: Patients were compared ac- cording to whether adequate antibi- otics were started when VAP was first suspected (D0). At day 0, the rate of adequate antibiotic therapy was 44.4% and rose to 92% at day 2. Outcomes were recorded at the ICU and hospital discharge. Overall, no significant mortality difference was found with and without adequate early antibiotics. When patients were also classified based on the initial Logistic Organ Dysfunction score (LOD), mortality was significantly higher with inadequate early antibi- otic therapy in the groups with LOD  4 (ICU mortality: 37% vs 7%, P=0.006; hospital mortality: 44% vs 15%, P=0.01). A multivariate logistic regression confirmed that inadequate antibiotic therapy increased mortality in patients with LOD  4 after ad- justment on other prognostic factors. Conclusions: Inadequate empirical treatment seemed to be associated with a poor prognosis only in patients with LOD  4. These results need to be confirmed by further studies be- fore any reappraisal of current guidelines for empirical antibiotic therapy of VAP can be envisaged. Keywords Ventilator-associated pneumonia · Initial antibiotic therapy · Baseline severity · LOD score · Prognosis · Mortality Introduction Ventilator-associated pneumonia (VAP) occurs in roughly 25% of the patients requiring mechanical ventilation for more than 48 h. It is responsible for high mortality rates and an increased length of stay in intensive care units (ICUs) [1, 2].