Clinical Differences Between Survivors and Non-Survivors of Ventilator-Associated Pneumonia: The Roles of Sulbactam/Ampicillin and Methicillin-Resistant Staphylococcus aureus

Masafumi Seki,1,2 Anna Takimoto,2 Manabu Inoue,2 Kazuya Niiyama,2 Ayumu Masuoka,2 Futoshi Kotajima2 1Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; 2Respiratory Support Team, Saitama Medical University International Medical Center, Hidaka, Saitama, JapanCorrespondence: Masafumi Seki, Division of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Yamane 1397-1, Hidaka, Saitama, 350-1298, Japan, Tel +81-42-984-4392, Fax +81-42-984-0280, Email [email protected]: Ventilator-associated pneumonia (VAP) is one of the most lethal complications in intensive care unit (ICU) patients. However, critical issues of non-survivors vary and are still unclear in VAP patients.Methods: The clinical differences between survivors and non-survivors of VAP were retrospectively analyzed in patients hospitalized from April 2023 to March 2024.Results: Of a total of 42 VAP patients, 22 (52.4%) survived, and 20 died. Survivors were significantly younger (69.1 vs 71.7 years, p < 0.01) and received sulbactam/ampicillin (SAM) as the initial antibiotics, significantly more (45.5% vs 10%, p = 0.006) than non-survivors. The male/female ratio and wards where they were managed were similar in both groups, but methicillin-resistant Staphylococcus aureus (MRSA) was detected significantly more frequently in non-survivors (4/4 = 100%).Conclusion: These data suggest that VAP patients who survived were younger and received treatment with narrow-spectrum antibiotics, such as SAM. Isolation of MRSA might be critical. These findings could influence antibiotic protocols and ICU management strategies to prevent infection with resistant bacteria to improve the prognosis of patients with VAP.Keywords: Methicillin-resistant Staphylococcus aureus, sulbactam/ampicillin, Pseudomonas aeruginosa, vancomycin, ventilator-associated pneumonia