Antibiotics and Ventilator-Associated Pneumonia
Between ticarcillin plus clavulanate and piperacillin plus tazobactam, which combination is more effective as empirical antibiotic therapy in ventilator-associated pneumonia (VAP)?

VAP is a common problem in the intensive care unit (ICU). The diagnosis of VAP is associated with a greater duration of mechanical ventilation and prolonged stay in the ICU, and VAP may influence mortality independent of other factors involved in the underlying critical illness. For that reason, prevention of VAP is at least as important as treating VAP. The diagnosis of VAP remains difficult, with conflicting evidence for the utility of invasive diagnostic measures.

When the diagnosis of VAP is made, the most common organisms are Gram-negative bacteria, though Gram-positive bacteria frequently play a role and fungal organisms may also contribute. For this reason, broad-spectrum antimicrobial coverage is recommended, at least for empiric coverage until the organism is identified and sensitivities are known. The 2 antibiotics you mention have nearly identical spectrums of coverage and both are penicillin (beta-lactam)-based drugs. For the purposes of VAP therapy, either antibiotic is appropriate.