Multicenter treatment and outcome evaluation of aspiration syndromes in critically ill patients.
BACKGROUND
Aspiration syndromes (pneumonia and pneumonitis) have significantly different processes. An evaluation of treatment and outcomes for these different syndromes has not been reported previously.


OBJECTIVE
To characterize and assess antimicrobial prescribing patterns for aspiration syndromes in intensive care unit (ICU) patients and describe outcomes of those patients.


METHODS
A retrospective, observational evaluation was conducted using a convenience sample of patients at 27 hospitals in North America; these patients were admitted to an adult ICU with a diagnosis of suspected/confirmed aspiration or had a suspected/confirmed aspiration while in the ICU. Hospital demographic, diagnosis, treatment, and clinical outcome data were collected.


RESULTS
Over a 12 month period, 187 patients were observed. Aspiration syndromes included suspected aspiration (31%; n = 58), aspiration pneumonitis (12%; n = 23), aspiration pneumonia (55%; n = 103), and diagnosis not available (1.6%; n = 3). Antimicrobial management for the aspiration syndromes was as follows: suspected aspiration: 59% single agent, 38% multiple agents, and 3% no therapy; aspiration pneumonitis: 48% single agent, 39% multiple agents, and 13% no therapy; aspiration pneumonia: 48% single agent, 52% multiple agents, and 0% no therapy. Antimicrobial therapy was prescribed in patients with suspected (97%) and confirmed (100%) aspiration. Antibiotic therapy duration was significantly longer for aspiration pneumonia (9.1 +/- 7.5 days) than for aspiration pneumonitis (5.2 +/- 3.6 days; p = 0.013). Length of ICU stay was similar across patient groups.


CONCLUSIONS
Antimicrobial agents are frequently prescribed to treat aspiration syndromes despite the lack of demonstrated efficacy for aspiration pneumonitis. Outcomes between aspiration syndromes were similar with the exception of duration of antibiotic treatment.
Kane-Gill
Sandra L
SL
Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Center for Pharmacoinformatics and Outcomes Research, Pittsburgh, PA 15261, USA. KaneSL@upmc.edu
Olsen
Keith M
KM
Rebuck
Jill A
JA
Rea
Rhonda S
RS
Boatwright
D Wesston
DW
Smythe
Maureen A
MA
Walker
Terrence R
TR
Lager
Stephanie L
SL
Hodgman
Tudy
T
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016638:Critical Illness; D004334:Drug Administration Schedule; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000302:isolation & purification / Q000472:pathogenicity; D006094:Gram-Positive Bacteria / Q000145:classification* / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011015:Pneumonia, Aspiration / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents