Ventilator-associated pneumonia in a multi-hospital system: differences in microbiology by location.
OBJECTIVE
To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.


METHODS
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.


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


METHODS
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.
Babcock
Hilary M
HM
Division of Infectious Diseases, Washington University School of Medicine, USA.
Zack
Jeanne E
JE
Garrison
Teresa
T
Trovillion
Ellen
E
Kollef
Marin H
MH
Fraser
Victoria J
VJ
D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology* / Q000635:transmission; D004866:Equipment Contamination; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity; D008923:Missouri / Q000453:epidemiology; D009096:Multi-Institutional Systems / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000472:pathogenicity; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D012122:Ventilators, Mechanical / Q000382:microbiology*