Does invasive diagnosis of nosocomial pneumonia during off-hours delay treatment?
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.
Luyt
Charles-Edouard
CE
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
Combes
Alain
A
Nieszkowska
Ania
A
Reynaud
Catherine
C
Tonnellier
Marc
M
Trouillet
Jean-Louis
JL
Chastre
Jean
J
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
D000900:Anti-Bacterial Agents