The Duration of Antibiotic Therapy for Early (DATE) Ventilator Associated Pneumonia (VAP): 4 vs. 7 Days

Inclusion Criteria:

1. Surgical patient

2. Early VAP, defined as VAP occurring within 2 - 7 days of intubation (viaendotracheal or tracheostomy tube) (9). VAP will be defined according to localinstitutional protocol.

3. Hospital length of stay (LOS) < 10 days at the time of VAP diagnosis.

4. Patients are willing to provide informed consent or their Legally AuthorizedRepresentative (LAR) is willing to provide informed consent on their behalf when thepatient is unable (i.e., cognitively impaired from sedation on a ventilator)

Exclusion Criteria:

1. Age < 18 years

2. Prior episode of VAP for the index admission

3. VAP caused by any of the following pathogens:

• Methicillin-resistant Staphylococcus aureus (MRSA)

• Vancomycin-intermediate Staphylococcus aureus (VISA)

• Pseudomonas aeruginosa

• Vancomycin-resistant Enterococcus (VRE)

• Acinetobacter baumanii

• Stenotrophomonas maltophilia

• Carbapenem-resistant Enterobacteriaceae (CRE)

• Extended-spectrum beta lactamase-producing gram-negative bacilli

4. Causative pathogen not sensitive to choice of initial empiric antibiotic

5. Antibiotic therapy for > 5 of the last 10 days preceding VAP diagnosis

6. Septic shock, defined as evidence of tissue hypoperfusion after adequate volumeexpansion, due to infection, and requiring > 1 vasopressor (17)

7. Current or recent (within 30 days) use of immunosuppressive medications

8. LOS > 72 hours at a transferring facility

9. Pregnancy or lactation

10. Legal arrest or incarceration

11. Moribund state in which death is imminent

12. ECMO (Extracorporeal membrane oxygenation)

13. Extubation prior to randomization