Skip to main content Accesibility Help
×
×
Home

Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

  • Hilary M. Babcock (a1), Jeanne E. Zack (a2), Teresa Garrison (a2), Ellen Trovillion (a2), Marin H. Kollef (a3) and Victoria J. Fraser (a1)...
Abstract
Objective:

To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.

Design:

Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.

Setting:

Three hospitals—one pediatric teaching hospital, one adult teaching hospital, and one community hospital— in one healthcare system in the midwestern United States.

Patients:

Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available.

Results:

Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P. aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs.

Conclusions:

Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.

Copyright
Corresponding author
Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110
References
Hide All
1. Richards, MJ, Edwards, JR, Culver, DH, et al. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887899.
2. George, DL. Epidemiology of nosocomial pneumonia in ICU patients. Clin Chest Med 1995;16:2944.
3. Fagon, JY, Chastre, J, Hance, AJ, et al. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281288.
4. Fagon, JY, Chastre, J, Vuagnat, A et al. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275:866899.
5. Warren, DK, Shukla, SJ, Olsen, MA, et al. The outcome and attributable cost of ventilator associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:13121317.
6. Cook, DJ, Walter, SD, Cook, RJ, et al. Incidence of and risk factors for ventilator associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433440.
7. Kollef, MH. Antimicrobial therapy of ventilator-associated pneumonia: how to select an appropriate drug regimen. Chest 1999;115:811. Letter.
8. Leu, HS, Kaiser, DL, Mori, M, et al. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:12581267.
9. Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462474.
10. Kollef, MH, Ward, S. The Influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest 1998;113:412420.
11. Luna, CM, Vujacich, P, Niederman, M, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676685.
12. Alvarez-Lerma, F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit: ICU-Acquired Pneumonia Study Group. Intensive Care Med 1996;22:387394.
13. Rello, J, Gallego, M, Marsical, D, et al. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med 1997;156:196200.
14. Kollef, MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 2000;31(suppl 4):S131S138.
15. Namias, N, Saiman, L, Nino, D, et al. Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital: implications for empiric antibiotic strategies. J Trauma 2000;49:638645.
16. Trouillet, JI, Chastre, J, Vuagnat, A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531539.
17. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
18. Kollef, MH, Silver, P, Murphy, DM, et al. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995;108:16551662.
19. Langer, M, Cigada, M, Mandelli, M, Mosconi, P, Tognoni, G. Early onset pneumonia: a multi-center study in intensive care units. Intensive Care Med 1987;13:342346.
20. Pingleton, SK, Fagon, JY, Leeper, KV Jr. Patient selection for clinical investigation of ventilator-associated pneumonia: criteria for evaluating diagnostic techniques. Chest 1992;102(5 suppl 1):553S556S.
21. Ibrahim, EH, Ward, S, Sherman, G, Kollef, MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest 2000;117:14341442.
22. Elward, AM, Warren, DK, Fraser, VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 2002;109:758764.
23. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, R. Nosocomial infections in pediatric intensive care units in the United States: National Nosocomial Infections Surveillance System. Pediatrics 1999;103:e39.
24. Rello, J, Sa Borges, M, Correa, H, Leal, SR, Baraibar, J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antibiotic prescribing practices. Am J Respir Crit Care. Med 1999;160:608613.
25. Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146155.
26. Ibrahim, EH, Ward, S, Sherman, G, Schaiff, R, Fraser, VJ, Kollef, MH. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001;29:11091115.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed