Influence of microbiological culture results on antibiotic choices for veterans with hospital-acquired pneumonia and ventilator-associated pneumonia
| Autor: | Federico Perez, Robin L.P. Jump, Brigid Wilson, Sunah Song, Robert A. Bonomo, Ukwen Akpoji, Taissa Bej, Robbie Lee Anne. Christian, Sharanie Sims |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Microbiological culture Epidemiology medicine.drug_class Antibiotics Hospital-acquired pneumonia medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine 030212 general & internal medicine Retrospective Studies Veterans 0303 health sciences 030306 microbiology business.industry Pseudomonas aeruginosa Healthcare-Associated Pneumonia Ventilator-associated pneumonia Pneumonia Ventilator-Associated Pneumonia medicine.disease Hospitals Anti-Bacterial Agents Infectious Diseases Vancomycin Sample collection business medicine.drug |
| Zdroj: | Infection Control & Hospital Epidemiology. 43:589-596 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1017/ice.2021.186 |
| Popis: | Objective:We examined the impact of microbiological results from respiratory samples on choice of antibiotic therapy in patients treated for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).Design:Four-year retrospective study.Setting:Veterans’ Health Administration (VHA).Patients:VHA patients hospitalized with HAP or VAP and with respiratory cultures between October 1, 2014, and September 30, 2018.Interventions:We compared patients with positive and negative respiratory culture results, assessing changes in antibiotic class and Antibiotic Spectrum Index (ASI) from the day of sample collection (day 0) through day 7.Results:Between October 1, 2014, and September 30, 2018, we identified 5,086 patients with HAP/VAP: 2,952 with positive culture results and 2,134 with negative culture results. All-cause 30-day mortality was 21% for both groups. The mean time from respiratory sample receipt in the laboratory to final respiratory culture result was longer for those with positive (2.9 ± 1.3 days) compared to negative results (2.5 ± 1.3 days; P < .001). The most common pathogens were Staphylococcus aureus and Pseudomonas aeruginosa. Vancomycin and β-lactam/β-lactamase inhibitors were the most commonly prescribed agents. The decrease in the median ASI from 13 to 8 between days 0 and 6 was similar among patients with positive and negative respiratory cultures. Patients with negative cultures were more likely to be off antibiotics from day 3 onward.Conclusions:The results of respiratory cultures had only a small influence on antibiotics used during the treatment of HAP/VAP. The decrease in ASI for both groups suggests the integration of antibiotic stewardship principles, including de-escalation, into the care of patients with HAP/VAP. |
| Databáze: | OpenAIRE |
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