PURPOSE: To identify the risk factors of ventilator-associated pneumonia (VAP) due to difficult-to-treat (DTT) bacteria (i.e., Pseudomonas aeruginosa, Acinetobacter baumannii and oxacillin-resistant Staphylococcus aureus), and to assess the rate and the causes of inappropriateness of empirical antimicrobial therapy. METHODS: In an intensive care unit of a university hospital, patients with VAP were empirically treated with antibiotics without activity against DTT bacteria if the patients had no prior hospitalization or prior administration of antibiotics, according to local guidelines. RESULTS: Overall, the empirical antimicrobial therapy was appropriate in 190 (87%) out of 218 patients with VAP. Fifty (23%) patients developed problems due to DTT bacteria. The risk factors for VAP due to DTT bacteria were shock state, prior antimicrobial therapy, prior stay in long-term care facilities and late-onset VAP. Empirical antimicrobial therapy was inappropriate in 20 (40%) patients with VAP due to DTT bacteria and 8 (5%) patients with VAP due to non-DTT (P = 0.001). Guidelines violations (nine patients), bacteria not included in antibiotic spectrum (eight patients) and bacterial resistance (three patients) were the causes of inappropriateness in case of DTT bacteria. CONCLUSION: Despite the abundant information for the treatment of VAP and the establishment of guidelines, too many patients with DTT bacteria received inappropriate antimicrobial therapy. Since 45% of the cases are related to non-adherence to the local protocol, there is room for improvement by implementing educational programs. Also, since DTT bacteria are found in 23% of late-onset VAP, empirical antibiotic treatment should be directed against these pathogens.
PURPOSE: To identify the risk factors of ventilator-associated pneumonia (VAP) due to difficult-to-treat (DTT) bacteria (i.e., Pseudomonas aeruginosa, Acinetobacter baumannii and oxacillin-resistant Staphylococcus aureus), and to assess the rate and the causes of inappropriateness of empirical antimicrobial therapy. METHODS: In an intensive care unit of a university hospital, patients with VAP were empirically treated with antibiotics without activity against DTT bacteria if the patients had no prior hospitalization or prior administration of antibiotics, according to local guidelines. RESULTS: Overall, the empirical antimicrobial therapy was appropriate in 190 (87%) out of 218 patients with VAP. Fifty (23%) patients developed problems due to DTT bacteria. The risk factors for VAP due to DTT bacteria were shock state, prior antimicrobial therapy, prior stay in long-term care facilities and late-onset VAP. Empirical antimicrobial therapy was inappropriate in 20 (40%) patients with VAP due to DTT bacteria and 8 (5%) patients with VAP due to non-DTT (P = 0.001). Guidelines violations (nine patients), bacteria not included in antibiotic spectrum (eight patients) and bacterial resistance (three patients) were the causes of inappropriateness in case of DTT bacteria. CONCLUSION: Despite the abundant information for the treatment of VAP and the establishment of guidelines, too many patients with DTT bacteria received inappropriate antimicrobial therapy. Since 45% of the cases are related to non-adherence to the local protocol, there is room for improvement by implementing educational programs. Also, since DTT bacteria are found in 23% of late-onset VAP, empirical antibiotic treatment should be directed against these pathogens.
Authors: Olivier Leroy; Agnès Meybeck; Thibaud d'Escrivan; Patrick Devos; Eric Kipnis; Hugues Georges Journal: Intensive Care Med Date: 2003-09-12 Impact factor: 17.440
Authors: Sergio E Trevino; Hilary M Babcock; Jeffrey P Henderson; Michael A Lane; Susan E Beekmann; Philip M Polgreen; Jonas Marschall Journal: J Antimicrob Chemother Date: 2015-09-07 Impact factor: 5.790
Authors: S Weiterer; D Störzinger; M Bernhard; K Mayer; C Lass-Flörl; M A Weigand; C Lichtenstern Journal: Anaesthesist Date: 2011-03 Impact factor: 1.041
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2011-01-12 Impact factor: 17.440
Authors: Marc Leone; Carole Bechis; Karine Baumstarck; Jean-Yves Lefrant; Jacques Albanèse; Samir Jaber; Alain Lepape; Jean-Michel Constantin; Laurent Papazian; Nicolas Bruder; Bernard Allaouchiche; Karine Bézulier; François Antonini; Julien Textoris; Claude Martin Journal: Intensive Care Med Date: 2014-08-05 Impact factor: 17.440
Authors: D C Richter; A Heininger; T Brenner; M Hochreiter; M Bernhard; J Briegel; S Dubler; B Grabein; A Hecker; W A Kruger; K Mayer; M W Pletz; D Storzinger; N Pinder; T Hoppe-Tichy; S Weiterer; S Zimmermann; A Brinkmann; M A Weigand; C Lichtenstern Journal: Anaesthesist Date: 2019-02 Impact factor: 1.041
Authors: D C Richter; A Heininger; T Brenner; M Hochreiter; M Bernhard; J Briegel; S Dubler; B Grabein; A Hecker; W A Krüger; K Mayer; M W Pletz; D Störzinger; N Pinder; T Hoppe-Tichy; S Weiterer; S Zimmermann; A Brinkmann; M A Weigand; Christoph Lichtenstern Journal: Anaesthesist Date: 2017-10 Impact factor: 1.041
Authors: Themoula Charalampous; Adela Alcolea-Medina; Luke B Snell; Tom G S Williams; Rahul Batra; Christopher Alder; Andrea Telatin; Luigi Camporota; Christopher I S Meadows; Duncan Wyncoll; Nicholas A Barrett; Carolyn J Hemsley; Lisa Bryan; William Newsholme; Sara E Boyd; Anna Green; Ula Mahadeva; Amita Patel; Penelope R Cliff; Andrew J Page; Justin O'Grady; Jonathan D Edgeworth Journal: Genome Med Date: 2021-11-17 Impact factor: 11.117