title: Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures.
abstract: OBJECTIVE
  To assess whether pathogen prediction in bacteremia associated with nosocomial pneumonia (NP) by tracheal surveillance cultures improves adequacy of early antibiotic therapy and impacts mortality.
  
  
  METHODS
  A retrospective observational study of a prospectively gathered cohort. This cohort included all adult patients admitted to the ICU of a tertiary care hospital from 1992 through 2001 and who developed bacteremia associated with NP.
  
  
  RESULTS
  128 episodes of bacteremia associated with NP were identified. In 110 episodes a tracheal surveillance culture 48-96h prior to bacteremia was available: this culture predicted the pathogen in 67 episodes (61%). Overall rates of appropriate empiric antibiotic therapy within 24 and 48h were 62 and 87%, respectively. Pathogen prediction was associated with a significantly higher rate of appropriate antibiotic therapy within 24h (71 vs 45%; p=0.01), but not within 48h (91 vs 82%; p=0.15). Crude in-hospital mortality was 50%. Pathogen prediction was associated with increased survival in univariate (OR 0.43; CI 0.19-0.93; p=0.04) and multivariate analysis (OR 0.32; CI 0.12-0.82; p=0.02). Multivariate analysis further identified age (OR 1.04; CI 1.01-1.07; p=0.02), increasing APACHEII score (OR 1.08; CI 1.02-1.15; p=0.01), and methicillin-resistant Staphylococcus aureus (OR 5.90; CI 1.36-25.36; p=0.01) and Pseudomonas aeruginosa (OR 3.30; CI 1.04-10.4; p=0.04) as independent risk factors for mortality.
  
  
  CONCLUSIONS
  Pathogen prediction in bacteremia associated with NP by tracheal surveillance cultures is associated with a higher rate of adequate empiric antibiotic therapy within 24[Symbol: see text]h and with increased survival.
authors.affiliation: Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. pieter.depuydt@ugent.be
authors.forename: Pieter
authors.initials: P
authors.lastname: Depuydt
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.forename: Dirk
authors.initials: D
authors.lastname: Vogelaers
authors.forename: Geert
authors.initials: G
authors.lastname: Claeys
authors.forename: Gerda
authors.initials: G
authors.lastname: Verschraegen
authors.forename: Koenraad
authors.initials: K
authors.lastname: Vandewoude
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy*; D018432:Drug Resistance, Multiple; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents