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To the Editor: Dr Chastre and colleagues¹ reported that an 8-day course of antibiotic therapy for ventilator-associated pneumonia (VAP) was equally effective as a 15-day course. I have some concerns about the design of this study. First, only 35% of the eligible patients were recruited after day 3, which could have biased the results. Only patients with an Acute Physiology and Chronic Health Evaluation score of less than 65 and no extrapulmonary infections were enrolled; the use of such strict exclusion criteria could have been responsible for the lack of difference between the longer and shorter regimen. It is possible that the shorter antibiotic regimen would not be equally effective in patients who are more critically ill.

Second, the authors excluded patients with immune suppression or other causes of neutropenia. Thus, I am puzzled that the authors report fungi as an etiologic agent of VAP in some patients. In immunocompetent . . . [Full Text of this Article]

Emanuele Nicastri, MD, PhD
nicastri@inmi.it
National Institute for Infectious Diseases
IRCCS L. Spallanzani
Rome, Italy

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