title: Does invasive diagnosis of nosocomial pneumonia during off-hours delay treatment?
abstract: OBJECTIVE
  We examined whether invasive lung-specimen collection-to-treatment times for intensive care unit patients with suspected ventilator-associated pneumonia (VAP) differ with to the work shift during which specimens were collected. We compared weekday day shifts and off-hours (from 6:30 p.m. to 8:29 a.m. the next day for night shifts, from Saturday 1:00 p.m. to Monday 8:29 a.m. for weekends, and from 8:30 a.m. to 8:29 a.m. the following morning for public holidays).
  
  
  METHODS
  Single-center, observational study in the intensive care unit in an academic teaching hospital.
  
  
  METHODS
  101 patients who developed 152 episodes of bacteriologically confirmed VAP.
  
  
  RESULTS
  Of the 152 VAP episodes 66 were diagnosed during off-hours. Neither more bronchoscopy complications nor more inappropriate initial antimicrobial treatments for patients were observed between day and off-hour shifts. Indeed, the overall time from brochoalveolar lavage to antibiotic administration was shorter for off-hours than day-shifts due to shorter specimen collection-to-antibiotic prescription times, but antibiotic prescription-to-administration times were the same.
  
  
  CONCLUSIONS
  An invasive strategy based on bronchoscopy to diagnose VAP was not associated with a longer time to first appropriate antibiotic administration when clinical suspicion of VAP occurs during off-hours.
authors.affiliation: Université Pierre et Marie Curie, Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. charles-edouard.luyt@psl.aphp.fr
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Ania
authors.initials: A
authors.lastname: Nieszkowska
authors.forename: Catherine
authors.initials: C
authors.lastname: Reynaud
authors.forename: Marc
authors.initials: M
authors.lastname: Tonnellier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents