Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clini
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EuRoPEan JouRnal of MEdIcal REsEaRcH
Eur J Med Res (2011) 16: 315-323
315 © I. Holzapfel Publishers 2011
GuIdElInE-adHEREnt InItIal IntRavEnous antIbIotIc tHERaPy foR H osPItal -acquIREd /v EntIlatoR - assocIatEd P nEuMonIa Is clInIcally suPERIoR, savEs lIvEs and Is cHEaPER tHan non GuIdElInE adHEREnt tHERaPy M. H. Wilke 1, R. f. Grube 1, K. f. bodmann 2 2 Head
1 dr. Wilke GmbH – inspiring.health, Munich, Germany of Internal Intensive care unit and interdisciplinary emergency medicine, Klinikum barnim – Werner forssmann hospital, Eberswalde, Germany
Abstract Introduction: Hospital-acquired pneumonia (HaP) often occurring as ventilator-associated pneumonia (vaP) is the most frequent hospital infection in intensive care units (Icu). Early adequate antimicrobial therapy is an essential determinant of clinical outcome. organisations like the German PEG or ats/ Idsa provide guidelines for the initial calculated treatment in the absence of pathogen identification. We conducted a retrospective chart review for patients with HaP/vaP and assessed whether the initial intravenous antibiotic therapy (IIat) was adequate according to the PEG guidelines Materials and Methods: We collected data from 5 tertiary care hospitals. Electronic data filtering identified 895 patients with potential HaP/vaP. after chart review we finally identified 221 patients meeting the definition of HaP/vaP. Primary study endpoints were clinical improvement, survival and length of stay. secondary endpoints included duration of mechanical ventilation, total costs, costs incurred on the intensive care unit (Icu), costs incurred on general wards and drug costs. Results: We found that 107 patients received adequate initial intravenous antibiotic therapy (IIat) vs. 114 with inadequate IIat according to the PEG guidelines. baseline characteristics of both groups revealed no significant differences and good comparability. clinical improvement was 64% over all patients and 82% (85/104) in the subpopulation with adequate IIat while only 47% (48/103) inadequately treated patients improved (p< 0.001). the odds ratio of therapeutic success with Ga versus nGa treatment was 5.821 (p 65 yrs
1
structural lung disease (e.g. coPd)
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Previous antibiotic treatment
2
late onset (5 or more days after admission)
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Invasive or non-invasive mechanical ventilation on onset date
3
Extrapulmonary organ failure
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the total complicated pathogen risk score (cPRs) is calculated by adding up all individual scores for risk factors identified in a given patient.
July 25, 2011
EuRoPEan JouRnal of MEdIcal REsEaRcH
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Table 1b. PEG therapeutic recommendations for HaP/vaP depending on the complicated pathogen risk score (cPRs). Group I (cPRs = 1 or 2)
aminopenicillin/blI or cephalosporin 2/3a or quinolone 3/4 or carbapenem 2
Group II (cPRs = 3 to 5)
acylaminopenicillin/blI or cephalosporin 3b/4 or quinolone 2/3 or carbapenem 1
Group III (cPRs = 6 and more)
cephalosporin 3b/4 or acylaminopenicilline/blI or carbapenem 1 Always in combination with either quinolone 2/
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