Reduction in inadequate empiric antibiotic therapy for ventilator- associated pneumonia

Impact of a unit-specific treatment pathway

Louis J. Magnotti, Thomas J. Schroeppel, Timothy C. Fabian, L. Paige Clement, Joseph Swanson, Peter Fischer, Tiffany K. Bee, George O. Maish, Gayle Minard, Ben L. Zarzaur, Martin Croce

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). Reported mortality rates for inadequate empiric antibiotic therapy (IEAT) for VAP range from 45 to 91 per cent. The purpose of this study was to determine the effect of a unit-specific pathway for the empiric management of VAP on reducing IEAT episodes and improving outcomes in trauma patients. Patients admitted with VAP over 36-months were identified and stratified by gender, age, severity of shock, and injury severity. Outcomes included number of IEAT episodes, ventilator days, intensive care unit days, hospital days, and mortality. Three hundred and ninety-three patients with 668 VAP episodes were identified. There were 144 (22%) IEAT episodes: significantly reduced compared with our previous study (39%) (P < 0.001). Patients were classified by number of IEAT episodes: 0 (n = 271), 1 (n = 98) and ≥ 2 (n = 24). Mortality was 12 per cent, 13 per cent, and 38 per cent (P < 0.001), respectively. Multivariable logistic regression identified multiple IEAT episodes as an independent predictor of mortality (odds ratio = 4.7; 95% confidence interval: 1.684-13.162). Multiple IEAT episodes were also associated with prolonged mechanical ventilation and intensive care unit stay (P < 0.001). Trauma patients with multiple IEAT episodes for VAP have increased morbidity and mortality. Adherence to a unit-specific pathway for the empiric management of VAP reduces multiple IEAT episodes. By limiting IEAT episodes, resource utilization and hospital mortality are significantly decreased.

Original languageEnglish (US)
Pages (from-to)516-522
Number of pages7
JournalAmerican Surgeon
Volume74
Issue number6
StatePublished - Jun 1 2008

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Ventilator-Associated Pneumonia
Anti-Bacterial Agents
Therapeutics
Mortality
Hospital Mortality
Intensive Care Units
Wounds and Injuries
Mechanical Ventilators
Artificial Respiration
Shock
Logistic Models
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Reduction in inadequate empiric antibiotic therapy for ventilator- associated pneumonia : Impact of a unit-specific treatment pathway. / Magnotti, Louis J.; Schroeppel, Thomas J.; Fabian, Timothy C.; Clement, L. Paige; Swanson, Joseph; Fischer, Peter; Bee, Tiffany K.; Maish, George O.; Minard, Gayle; Zarzaur, Ben L.; Croce, Martin.

In: American Surgeon, Vol. 74, No. 6, 01.06.2008, p. 516-522.

Research output: Contribution to journalArticle

Magnotti, LJ, Schroeppel, TJ, Fabian, TC, Clement, LP, Swanson, J, Fischer, P, Bee, TK, Maish, GO, Minard, G, Zarzaur, BL & Croce, M 2008, 'Reduction in inadequate empiric antibiotic therapy for ventilator- associated pneumonia: Impact of a unit-specific treatment pathway', American Surgeon, vol. 74, no. 6, pp. 516-522.
Magnotti, Louis J. ; Schroeppel, Thomas J. ; Fabian, Timothy C. ; Clement, L. Paige ; Swanson, Joseph ; Fischer, Peter ; Bee, Tiffany K. ; Maish, George O. ; Minard, Gayle ; Zarzaur, Ben L. ; Croce, Martin. / Reduction in inadequate empiric antibiotic therapy for ventilator- associated pneumonia : Impact of a unit-specific treatment pathway. In: American Surgeon. 2008 ; Vol. 74, No. 6. pp. 516-522.
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