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Chest. 2006 May;129(5):1210-8.

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia.

Author information

1
Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110, USA. mkollef@im.wustl.edu

Erratum in

  • Chest. 2006 Jul;130(1):308.

Abstract

STUDY OBJECTIVES:

To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy.

DESIGN:

Prospective, observational, cohort study.

SETTING:

Twenty ICUs throughout the United States.

PATIENTS:

A total of 398 ICU patients meeting predefined criteria for suspected VAP.

INTERVENTIONS:

Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes.

MEASUREMENTS AND RESULTS:

The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%), and cardiac complications (10.8%). The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 +/- 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 +/- 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2 days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; chi2= 13.25; p = 0.001).

CONCLUSIONS:

Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants further clinical study.

PMID:
16685011
DOI:
10.1378/chest.129.5.1210
[Indexed for MEDLINE]

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