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Although our sample size does not allow drawing conclusions, the microbiological persistence seems to be associated with a worse VAP clinical response.
Another approach has been to use "microbiological eradication" or "microbiological persistence" as an outcome measure [ 16, 18- 20].
The hazard ratio for microbiological persistence in patients treated with colistin compared with tobramycin was 0.90 (95% CI 0.46 to 1.76).
These investigators found no significant differences in mortality, the mean increase in creatinine or rates of microbiological persistence at day 7 between colistin-exposed and non-exposed patients [ 15].
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The main reasons for switching to salvage therapy included clinical failure of the first-line therapy (69%), microbiological documentation of persistence of the infection (8.4%), or toxicity associated with the first-line therapy (10.8%).
One study reported persistence of microbiological infection of 75% and clinical persistence or recurrence of 38% in patients with MDR P. aeruginosa infection versus 61% and 39% respectively, in the non-MDR P. aeruginosa group [ 56].
Patients with an initial positive culture and at least one follow-up culture were considered microbiologically evaluable and were evaluated as "microbiological success" (eradication) or "microbiological failure" (persistence or superinfection) at discharge.
Microbiological failure was defined as the persistence of pathogen(s) in laboratory samples or as the development of a new infection.
Outcome measures include 30-day mortality post-ASP review, unplanned re-admission within 30 days post-discharge from hospital, and clinical deterioration at 7 days post-ASP review – a composite measure comprising persistence of fever (if febrile), failure of microbiological clearance, and lack of general physiological improvement defined by the primary physicians' records.
The aim of this study is to evaluate the influence of the persistence of viable microorganisms in the ETT biofilm on clinical and microbiological response to VAP.
However, it is unclear if the persistence of IFN-γ responses detected in IGRA assay will be predictive of clinical and microbiological treatment failure or relapse.
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