Effectiveness of Short-Course Versus Standard Antibiotic Therapy in ICU Patients

This study will enroll subjects who have been hospitalized at least three days (on or after fourth day of hospital stay), who have new pulmonary infiltrates during their ICU stay and who are at low risk of having pneumonia, as determined using the Clinical Pulmonary Infection Score (CPIS). The study is designed to determine whether 3 days of antibiotic treatment with meropenem (with or without coverage for MRSA) can reduce the risk of colonization with antimicrobial-resistant bacteria or the isolation of a potential pathogen compared to a standard antibiotic therapy (minimum of 8 days of therapy with antibiotics of the primary care team's choosing). The study will also examine whether short-course therapy reduces length of ICU and hospital LOS and costs based on ICU and hospital LOS, antibiotic treatment, and standardized costs related to the treatment of infection-related adverse experiences, without having a negative effect on subject mortality or the incidence of clinically significant infection.

• INCLUSION CRITERIA:

The study will be limited to the medical, surgical, neurosurgical, trauma, and general ICUs of the participating institutions. Burn ICUs are not eligible for this study.

Subjects who meet all of the following criteria are eligible for enrollment into the study:

• Subject, or legal representative, has given written informed consent.
• Subject has developed a new pulmonary infiltrate (confirmed by radiology), after ICU admission.
• Subject has been hospitalized at least 3 days.
• CPIS less than or equal to 6.
• 18 years of age or older.

Exclusion criteria

Subjects who meet any of the following criteria are ineligible for participation in the study:

• Burn patients.
• Cystic fibrosis patients.
• Bone marrow or solid organ transplant patients.
• Neutropenia from any cause (absolute neutrophil count (ANC) < 500), or likely to become neutropenic within 7 days.
• Known or suspected Human Immunodeficiency Virus (HIV) infection (HIV test is not required).
• Suspected or proven extrapulmonary infection site requiring antibiotic therapy.
• History of anaphylaxis to penicillin or cephalosporins.
• History of anaphylaxis to meropenem (any component of the formulation), or other carbapenems (e.g., imipenem).
• On systemic antibiotics for more than 7 consecutive days during the previous 30 days.
• Received more than two doses of systemic antibiotics within the past 24 hours (other than those used for surgical prophylaxis).
• Pregnant or lactating. (Women of childbearing potential must have a negative serum or urine pregnancy test within the 7 days prior to the first dose of antibiotics.)
• On mechanical ventilation for > 7 consecutive days during the previous 30 days.
• Unlikely to survive past Day 7 of the study (as determined by the primary care team).
• Previous enrollment in this study.