Treatment of ventilator-associated pneumonia and ventilator-associated tracheobronchitis in the intensive care unit. A national survey of clinicians and pharmacists in Saudi Arabia

OBJECTIVES

To assess current practices of different healthcare providers for treating extensively drug-resistant (XDR)  Acinetobacter baumannii (AB) infections  in tertiary-care centers in Saudi Arabia. 

METHODS

This cross-sectional study was performed in  tertiary-care centers of Saudi Arabia between March and June 2014. A questionnaire consisting of 3 parts (respondent characteristics; case scenarios on ventilator-associated pneumonia [VAP] and tracheobronchitis [VAT], and antibiotic choices in each scenario) was developed and sent electronically to participants in 34 centers across Saudi Arabia. 

RESULTS

One-hundred and eighty-three respondents completed the survey. Most of the respondents (54.6%) preferred to use colistin-based combination therapy to treat VAP caused by XDR AB, and 62.8% chose to continue treatment for 2 weeks. Most of the participants (80%) chose to treat VAT caused by XDR AB with intravenous antibiotics. A significant percentage of intensive care unit (ICU) fellows (41.3%) and clinical pharmacists (35%) opted for 2 million units (mu) of colistin every 8 hours without a loading dose, whereas 60% of infectious disease consultants, 45.8% of ICU consultants, and 44.4% of infectious disease fellows preferred a 9 mu loading dose followed by 9 mu daily in divided doses. The responses for the scenarios were different among healthcare providers (p less than 0.0001). 

CONCLUSION

Most of the respondents in our survey preferred to use colistin-based combination therapy and intravenous antibiotics to treat VAP and VAT caused by XDR AB. However, colistin dose and duration varied among the healthcare providers.

Inhibition of cartilage growth by the anticonvulsant drugs diphenylhydantoin and sodium valproate

Anticonvulsant-treated epileptic children have reduced growth and show skeletal deformities similar to those seen in hypoparathyroidism. In view of the crucial role of chondrocytes in endochondral bone growth we investigated the effects of anticonvulsant drugs on cartilage growth in rats. Rats were injected i.p. with diphenylhydantoin (PHT) or sodium valproate (dipropyl acetate; DPA), or were thyroparathyroidectomized (TPX) to render them deficient in parathyroid hormone (PTH). Cartilage growth, measured as the increase in thickness and cross-sectional area of the femoral epiphysis and the mandibular condyle cartilage, was significantly reduced in the PHT and TPX groups compared with control animals receiving the drug vehicle alone or a 'sham' TPX operation. The cellularity of the cartilage was reduced in all three treatment groups, but DPA had less effect than PHT or TPX. The similarity in effect between TPX and anticonvulsant treatment suggest the drugs may also interfere with the regulation of chondrocyte activity proliferation and matrix synthesis are reduced by anticonvulsant therapy, and that this contributes to the pathogenesis of abnormal skeletal growth in anticonvulsant-treated children.