title: Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia.
abstract: The objectives of this study were to assess the determinants of empirical antibiotic choice, prescription patterns and outcomes in patients with hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in Europe. We performed a prospective, observational cohort study in 27 intensive care units (ICUs) from nine European countries. 100 consecutive patients on mechanical ventilation for HAP, on mechanical ventilation>48 h or with VAP were enrolled per ICU. Admission category, sickness severity and Acinetobacter spp. prevalence>10% in pneumonia episodes determined antibiotic empirical choice. Trauma patients were more often prescribed non-anti-Pseudomonas cephalosporins (OR 2.68, 95% CI 1.50-4.78). Surgical patients received less aminoglycosides (OR 0.26, 95% CI 0.14-0.49). A significant correlation (p<0.01) was found between Simplified Acute Physiology Score II score and carbapenem prescription. Basal Acinetobacter spp. prevalence>10% dramatically increased the prescription of carbapenems (OR 3.5, 95% CI 2.0-6.1) and colistin (OR 115.7, 95% CI 6.9-1,930.9). Appropriate empirical antibiotics decreased ICU length of stay by 6 days (26.3±19.8 days versus 32.8±29.4 days; p=0.04). The antibiotics that were prescribed most were carbapenems, piperacillin/tazobactam and quinolones. Median (interquartile range) duration of antibiotic therapy was 9 (6-12) days. Anti-methicillin-resistant Staphylococcus aureus agents were prescribed in 38.4% of VAP episodes. Admission category, sickness severity and basal Acinetobacter prevalence>10% in pneumonia episodes were the major determinants of antibiotic choice at the bedside. Across Europe, carbapenems were the antibiotic most prescribed for HAP/VAP.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain. jrello.hj23.ics@gencat.cat
authors.forename: J
authors.initials: J
authors.lastname: Rello
authors.forename: M
authors.initials: M
authors.lastname: Ulldemolins
authors.forename: T
authors.initials: T
authors.lastname: Lisboa
authors.forename: D
authors.initials: D
authors.lastname: Koulenti
authors.forename: R
authors.initials: R
authors.lastname: Mañez
authors.forename: I
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: J J
authors.initials: JJ
authors.lastname: De Waele
authors.forename: C
authors.initials: C
authors.lastname: Putensen
authors.forename: M
authors.initials: M
authors.lastname: Guven
authors.forename: M
authors.initials: M
authors.lastname: Deja
authors.forename: E
authors.initials: E
authors.lastname: Diaz
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D005060:Europe; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000453:epidemiology; D015363:Quinolones / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015363:Quinolones; D010878:Piperacillin; D003091:Colistin