Reply to Boyer et al

To the Editor—Dr Boyer and colleagues express concern that many of the patients in our study might not have had true ventilator-associated pneumonia (VAP) but rather ventilator-associated tracheobronchitis or atelectasis [1]. We wish to clarify that the purpose of our study was not to prove that very short antibiotic courses are safe in patients with definite VAP but rather to evaluate a possible strategy to de-escalate antibiotics in patients with suspected VAP [2]. The clinical reality is that we have no way of knowing which patients definitely have VAP [3]. Many patients are therefore started on empiric antibiotics for the possibility of VAP in accordance with current guidelines, but we know that many of these patients do not in fact have VAP [4–6]. How do we balance between early empiric therapy for possible VAP vs overutilization of antibiotics? We believe we need practical strategies to help clinicians identify suitable candidates for early discontinuation of antibiotics. Our study suggests that assessing serial ventilator settings may be one way to do this.

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