Trial of Antimicrobial Restraint in Presumed Pneumonia (TARPP)
Healthcare-Associated Pneumonia, Sepsis
About this trial
This is an interventional treatment trial for Healthcare-Associated Pneumonia
Eligibility Criteria
Inclusion Criteria:
- Intubated patients admitted to a surgical or trauma intensive care unit that have had an appropriate quantitative or semi-quantitative endobronchial sputum culture sent ≥48 hours into their ICU admission
- Primary pathology managed by surgical specialty
- Age ≥18 years.
Exclusion Criteria:
- Non-intubated patients.
- Intubated patients with concern for active infection that is not suspected to be pneumonia (i.e. intra-abdominal infection, skin and soft tissue infection, urinary tract infection, etc.)
- Primary disease not surgical or traumatic in nature
- Primary diagnosis of burns
- Incarcerated status
- Pregnant status or delivery during this hospitalization.
- On active immunosuppressive medications (or taking as a home medication prior to arrival)
Sites / Locations
- KU Medical Center
Arms of the Study
Arm 1
Arm 2
Other
Other
Aggressive Arm
Conservative Arm
If an intubated patient is suspected of having an ICU-acquired HAP/VAP during the aggressive period, antimicrobials should be initiated immediately after quantitative or semi-quantitative endobronchial cultures are sent regardless of clinical status. This will include patients who, as determined by the attending intensivist, are in sepsis or septic shock. If, after 72 hours, cultures and other clinical data do not point to a pneumonia, the antimicrobials should be stopped in the absence of another source of infection.
If a patient is suspected of having an ICU-acquired HAP/VAP during the conservative period, quantitative or semi-quantitative endobronchial cultures should be sent. If the patient is in septic shock persistent hypotension requiring vasoactive medications to maintain mean arterial pressure (MAP) ≥65 mm HG or persistent lactic acidosis (>2 mmol/L) despite adequate resuscitation) antimicrobials will be initiated immediately. If the patient has new onset organ dysfunction that is presumed to be due to infection (sepsis) then antimicrobials will be initiated at the discretion of the attending intensivist. In the absence of septic shock or sepsis (intensivist discretion), antimicrobials will not be initiated unless objective evidence of pneumonia is present or another documented source of infection is identified mandating treatment with antimicrobials.