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Chest. 2008 Aug;134(2):281-7. doi: 10.1378/chest.08-1116.

Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria.

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  • 1Washington University School of Medicine, St. Louis, MO 63110, USA.

Abstract

OBJECTIVE:

To identify predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia (VAP) attributed to potentially antibiotic-resistant Gram-negative bacteria (PARGNB) [Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia].

DESIGN:

A retrospective, single-center, observational cohort study.

SETTING:

Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.

PATIENTS:

Adult patients requiring hospitalization with microbiologically confirmed VAP attributed to PARGNB.

INTERVENTIONS:

Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

MEASUREMENTS AND MAIN RESULTS:

Seventy-six patients with VAP attributed to PARGNB were identified over a 5-year period. Nineteen patients (25.0%) died during hospitalization. Patients receiving their first dose of appropriate antibiotic therapy within 24 h of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy >24 h after BAL (17.2% vs 50.0%; p = 0.005). VAP due to Acinetobacter species was most often initially treated with an inappropriate antibiotic regimen, followed by S maltophilia and P aeruginosa (66.7% vs 33.3% vs 17.2%; p = 0.017). Overall, total hospitalization costs were statistically similar in patients initially treated with an inappropriate antibiotic regimen compared to an appropriate regimen ($68,597 +/- $55,466 vs $86,644 +/- $64,433; p = 0.390).

CONCLUSIONS:

These data suggest that inappropriate initial antibiotic therapy of microbiologically confirmed VAP attributed to PARGNB is associated with greater 30-day mortality. High rates of VAP attributed to antibiotic-resistant bacteria (eg, Acinetobacter species) may require changes in the local empiric antibiotic treatment of VAP in order to optimize the prescription of appropriate initial therapy.

[PubMed - indexed for MEDLINE]
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