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Research Snapshot Theater: Infectious Disease/Cardiovascular/Neuroscience, Adult

Doxycycline for Prevention of Ventilator-Associated Pneumonia in Neurocritically Ill Patients

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 12

  • Michelle L. Payne, PharmD, BCCCP

    Rhode Island

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • KG

    Kevin Gibas, MD

    Physician, Infectious Diseases
    Rhode Island Hospital

    Disclosure information not submitted.

  • LM

    Leonard Mermel, DO

    Physician, Infectious Diseases
    Rhode Island Hospital

    Disclosure information not submitted.

  • CC

    Cheston Cunha, MD

    Physician, Infectious Diseases
    Rhode Island Hospital

    Disclosure information not submitted.

  • TB

    Torrey Birch, MD

    Director, Neurocritical Care
    Rhode Island Hospital

    Disclosure information not submitted.

Introduction: Neurocritically ill patients are at high risk of ventilator-associated pneumonia (VAP), with incidences ranging from 20% to 76%. Short courses of antimicrobial prophylaxis have been shown to reduce early VAP following stroke or cardiac arrest and may be associated with better clinical outcomes. The PROPHY-VAP trial found that a dose of ceftriaxone within 12 hours of intubation reduced early VAP following acute brain injury. The purpose of this study was to evaluate a practice change following the results of PROPHY-VAP on early VAP in neurocritically ill patients.


Methods: This was an observational study evaluating a single dose of doxycycline 100mg (selected based on institutional susceptibilities) administered within 12 hours of intubation as part of a quality improvement initiative. Adult patients in the neurocritical care unit who were intubated within 48 hours of admission between November 1, 2023-April 30, 2024 (Pre cohort) and November 1, 2024-April 30, 2025 and received prophylactic doxycycline (Post cohort) were included. Exclusion criteria included predicted duration of mechanical ventilation < 48 hours, systemic antimicrobials for an active infection or other indication within 24 hours of intubation, pregnancy, and prisoner status. The primary endpoint was the incidence of early VAP which required positive sputum culture, clinical diagnosis, and radiologic findings suggestive of pneumonia within 7 days of intubation. Secondary endpoints included duration of mechanical ventilation, ICU and hospital length of stay (LOS), and in-hospital mortality.


Results: A total of 61 patients were included: 48 in the Pre cohort and 13 in the Post cohort. Baseline characteristics were similar. The incidence of early VAP was 14.6% and 7.7% in the Pre and Post cohorts, respectively (OR 2.05, p=1.00). There were no significant differences in the duration of mechanical ventilation (p=0.639), ICU LOS (p=0.101), hospital LOS (p=0.684), and in-hospital mortality (p=0.311).


Conclusions: In neurocritically ill patients, a single dose of doxycycline at the time of intubation did not reduce the incidence of early VAP; however, the sample size limited our ability to detect a significant difference. Further evaluation of the microbiological impacts of this intervention should be conducted on a larger scale.