Microbiology, empiric therapy and its impact on the outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2014-2019.

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Citation: Infection Control & Hospital Epidemiology. 43(3):277-283, 2022 03.PMID: 35322770Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Healthcare-Associated Pneumonia | *Pneumonia, Bacterial | *Pneumonia, Ventilator-Associated | Anti-Bacterial Agents/tu [Therapeutic Use] | Carbapenems/tu [Therapeutic Use] | Escherichia coli | Healthcare-Associated Pneumonia/dt [Drug Therapy] | Healthcare-Associated Pneumonia/ep [Epidemiology] | Hospitals | Humans | Pneumonia, Bacterial/dt [Drug Therapy] | Pneumonia, Ventilator-Associated/dt [Drug Therapy] | Pneumonia, Ventilator-Associated/ep [Epidemiology] | Retrospective Studies | Staphylococcus aureus | United States/ep [Epidemiology] | Ventilators, MechanicalYear: 2022ISSN:
  • 0899-823X
Name of journal: Infection control and hospital epidemiologyAbstract: CONCLUSIONS: Substantial microbiologic differences exist among populations who suffer nvHABP, vHABP, and VABP, and inappropriate empiric treatment significantly worsens utilization outcomes. Given the moderate rates of carbapenem resistance and third-generation cephalosporin resistance, all patients require empiric coverage for a range of bacteria, including those targeting extended-spectrum beta-lactamase and carbapenem resistance where appropriate.DESIGN: Multicenter retrospective cohort study within Premier Research database, 2014-2019.METHODS: We identified cases based on a previously published International Classification of Disease, Ninth Revision/Tenth Revision Clinical Modification (ICD-9/ICD-10-CM) algorithm, and we compared the 3 groups with respect to the bacterial pathogens isolated from their blood, sputum, or lower airway samples, and their respective rates of exposure to inappropriate empiric treatment. Using regression modeling we computed the effect of inappropriate empiric treatment on outcomes.OBJECTIVE: To explore whether microbiology profiles and the impact of inappropriate empiric treatment differ in the setting of hospital-acquired bacterial pneumonia that requires subsequent mechanical ventilation (vHABP) versus one that does not (nvHABP) versus ventilator-associated bacterial pneumonia (VABP).RESULTS: Among 17,819 patients who met enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. S. aureus (majority methicillin-susceptible) was the most frequently isolated organism, followed P. aeruginosa, K. pneumoniae, and E. coli with variations across the conditions. Rates of carbapenem resistance were highest in VABP (9.1%) and to third-generation cephalosporins in vHABP (14.9%). Patients with nvHABP were most likely to receive inappropriate empiric treatment (8.5%). Although inappropriate empiric treatment was associated with an increase in adjusted postinfection-onset hospital length of stay (2.3 days) and cost (All authors: Nathanson BH, Puzniak LA, Shorr AF, Zilberberg MDOriginally published: Infection Control & Hospital Epidemiology. 43(3):277-283, 2022 Mar.Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-05-11
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Journal Article MedStar Authors Catalog Article 35322770 Available 35322770

CONCLUSIONS: Substantial microbiologic differences exist among populations who suffer nvHABP, vHABP, and VABP, and inappropriate empiric treatment significantly worsens utilization outcomes. Given the moderate rates of carbapenem resistance and third-generation cephalosporin resistance, all patients require empiric coverage for a range of bacteria, including those targeting extended-spectrum beta-lactamase and carbapenem resistance where appropriate.

DESIGN: Multicenter retrospective cohort study within Premier Research database, 2014-2019.

METHODS: We identified cases based on a previously published International Classification of Disease, Ninth Revision/Tenth Revision Clinical Modification (ICD-9/ICD-10-CM) algorithm, and we compared the 3 groups with respect to the bacterial pathogens isolated from their blood, sputum, or lower airway samples, and their respective rates of exposure to inappropriate empiric treatment. Using regression modeling we computed the effect of inappropriate empiric treatment on outcomes.

OBJECTIVE: To explore whether microbiology profiles and the impact of inappropriate empiric treatment differ in the setting of hospital-acquired bacterial pneumonia that requires subsequent mechanical ventilation (vHABP) versus one that does not (nvHABP) versus ventilator-associated bacterial pneumonia (VABP).

RESULTS: Among 17,819 patients who met enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. S. aureus (majority methicillin-susceptible) was the most frequently isolated organism, followed P. aeruginosa, K. pneumoniae, and E. coli with variations across the conditions. Rates of carbapenem resistance were highest in VABP (9.1%) and to third-generation cephalosporins in vHABP (14.9%). Patients with nvHABP were most likely to receive inappropriate empiric treatment (8.5%). Although inappropriate empiric treatment was associated with an increase in adjusted postinfection-onset hospital length of stay (2.3 days) and cost ( 2,142), its greatest magnitude was in the nvHABP group (4.9 days, 3,147).

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