Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia.
OBJECTIVE
Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in nonventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.


METHODS
Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.


METHODS
A tertiary care academic hospital.


METHODS
All patients admitted from 2000 through 2003.


RESULTS
A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% (Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).


CONCLUSIONS
Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.
Weber
David J
DJ
Department of Hospital Epidemiology, University of North Carolina Health Care System, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA. dweber@unch.unc.edu
Rutala
William A
WA
Sickbert-Bennett
Emily E
EE
Samsa
Gregory P
GP
Brown
Vickie
V
Niederman
Michael S
MS
D003428:Cross Infection / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control / Q000379:methods; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology*; D011446:Prospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology