title: Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria.
abstract: OBJECTIVE
  To identify predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia (VAP) attributed to potentially antibiotic-resistant Gram-negative bacteria (PARGNB) [Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia].
  
  
  METHODS
  A retrospective, single-center, observational cohort study.
  
  
  METHODS
  Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.
  
  
  METHODS
  Adult patients requiring hospitalization with microbiologically confirmed VAP attributed to PARGNB.
  
  
  METHODS
  Retrospective data collection from automated hospital, microbiology, and pharmacy databases.
  
  
  RESULTS
  Seventy-six patients with VAP attributed to PARGNB were identified over a 5-year period. Nineteen patients (25.0%) died during hospitalization. Patients receiving their first dose of appropriate antibiotic therapy within 24 h of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy >24 h after BAL (17.2% vs 50.0%; p = 0.005). VAP due to Acinetobacter species was most often initially treated with an inappropriate antibiotic regimen, followed by S maltophilia and P aeruginosa (66.7% vs 33.3% vs 17.2%; p = 0.017). Overall, total hospitalization costs were statistically similar in patients initially treated with an inappropriate antibiotic regimen compared to an appropriate regimen ($68,597 +/- $55,466 vs $86,644 +/- $64,433; p = 0.390).
  
  
  CONCLUSIONS
  These data suggest that inappropriate initial antibiotic therapy of microbiologically confirmed VAP attributed to PARGNB is associated with greater 30-day mortality. High rates of VAP attributed to antibiotic-resistant bacteria (eg, Acinetobacter species) may require changes in the local empiric antibiotic treatment of VAP in order to optimize the prescription of appropriate initial therapy.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Kollef
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
authors.forename: Garrett E
authors.initials: GE
authors.lastname: Schramm
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Wills
authors.affiliation: Center for Quality and Effectiveness, BJC Healthcare, St. Louis, MO.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Reichley
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO. Electronic address: mkollef@im.wustl.edu.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents