Methods
pneumonia, fever, pulmonary infection, PA-VAP, extra-pulmonary infection
RECURRENCE, PNEUMONIA, PULMONARY INFECTION, SECONDARY, PULMONARY INFECTIONS, SEPTIC SHOCK, LEUKOCYTOSIS
The iDIAPASON trial [Adult patients were eligible in iDIAPASON trial if they met the following criteria for PA-VAP: a clinical suspicion (≥ two criteria including fever > 38·5 °C, leukocytosis > 10Antibiotic therapy was initiated after bacteriological respiratory sampling, without waiting for the results of microbiological analysis (bacteria identification and/or results of antimicrobial susceptibility testing—AST). The choice of initial antibiotic therapy was left to the discretion of the physician according to usual care based on the clinical context, previous antibiotic therapy, the presence or absence of risk factors for multidrug-resistant (MDR) pathogen or hospitalization in the previous 90 days (current hospitalization ≥ 5 days, mechanical ventilation ≥ 5 days, support in a dialysis center or residency in a nursing home), local epidemiological data, and finally, knowledge that the patient is already known as being colonized by a MDR pathogen. In the presence of risk factor of MDR pathogen and/or in case of septic shock, broad-spectrum antibiotic was recommended immediately, with the association of a β-lactam/β-lactamase inhibitor or an antipseudomonal cephalosporin, and an aminoglycoside or an antipseudomonal fluoroquinolone for 3–5 days. Initial antibiotic therapy with a narrow spectrum was possible in case of early-onset pneumonia (mechanical ventilation < 5 days) and in the absence of risk factors for MDR pathogens. In all cases, investigators were strongly encouraged to adapt the initial regimen into a narrower spectrum therapy, based on culture results and AST. Antibiotic therapy had to be interrupted, either at the end of day 8 or day 15, according to the randomization group, excluding antibiotic therapy for a documented pulmonary infection recurrence or a new extra-pulmonary infection before that day.The primary outcome of the present study was the mortality rate at day 90. The secondary outcomes included PA-VAP recurrence rate, invasive mechanical ventilation duration, ICU stay duration, antibiotic exposure duration, number and types of extra pulmonary infections, and acquisition of MDR pathogens (from swab sample of rectum and anterior nares).Recurrence was defined with a post hoc diagnosis by two independent experts blinded to the treatment arms with predefined criteria: clinical suspicion of VAP after at least 48 h without active antibiotic therapy for 