The Effects Of Optimized Anti-infection Therapy On Outcomes In ARDS Patients: A Multicentre, Prospective, Randomized, Open And Controlled Clinical Trial

Objective: To investigate the effect of optimized anti-infection therapy onoutcomes in ARDS patients.Methods: A multicentre, prospective, randomized, open and controlledclinical study. All patients admitted to SICU, RICU in Chengdu MilitaryArea General Hospital and EICU, SICU in the people hospital of Sichuanprovince between May2012and January2013were selected and randomizedinto two groups. Intervention group（IG）: The optimized anti-infectiontherapy were carried out in all patients by research personnel in this group.The optimized anti-infection therapies are as following:（1）Etiology testswere practiced before using antibiotics and changing antibiotics. The testsinclude sputum smear, sputum culture, blood culture and other body fluid,secretion etiology tests.（2） Empirical antibiotic therapy must cover thecommon pathogenic bacteria.（3） The empirical antibiotic therapy for severeinfection must consistent onset in time, hitting hard with combination ofbroad-spectrum antibiotics.（4） De-escalation treatment strategy. Agoal-directed therapy is practiced after identifying etiology within24hours. （5）Short course treatment strategy. The course of treatment is usuallyfrom7to10days，sometimes may prolong to10to15days for specificpathogenic bacteria.（6）Cycling use of antibiotics. To change antibiotics after5to8days treatment for some difficult infections.（7）Evaluation strategiesof anti-infection therapy. Evaluation of anti-infection can be found in thepaper of patients. Control group(CG)：All indices were collected as same as inintervention group and no interfering measure from investigator wasadministrated to all patients.Retrospective control group(RCG)：All caseswere from the old ARDS patients who were admitted to Chengdu MilitaryGeneral Hospital between January2005and December2011.The observationindices were same as in the other two groups.Observation indices:①pathogens；②Length of mechanical ventilation；③Hospital length ofstay(LOS) and ICU LOS；④7-Days and28-Days mortality；⑤Bacterialclearance rate；⑥Evaluation of anti-infection effect；⑦.Evaluation on therationality of antibiotic using；⑧Hospitalization costResults:42patients were selected and40patients enrolled in the prospectivestudy.Other20old patients were also enrolled as retrospective control group.Among IG,CG and RCG,there were no statistical difference between each otherin the main demograpic indices, disease severity,pathogen distribution,7-daymortality,28-day mortality and hospital LOS.However,some tendency appearedin cost reduction and shortness of ICU LOS.Comparing with CG,IG weresuperior in length of ventilation, bacterium clearance rate, anti-infection effect evaluation and rationality of antibiotics administration with significantdifference.Conclusions：1.The top three pathogenic bacteria associated with ARDS related infection areA.Baumanii,Pseudomonas aeruginosa and Fungus.2. The optimized anti-infection therapy in ARDS may shorten ICU LOS andreduce hospitalization related cost, but there is no significant influence inhospital LOS.3. The optimized anti-infection therapy may not change7-Days mortality and28-Days mortality notably in ARDS patients.4. The optimized anti-infection therapy can improve the length of ventilation,bacterium clearance rate, anti-infection effect evaluation and rationality ofantibiotics administration in ARDS patients,thus can improve the prognosis ofARDS patients.