title: Identifying missed opportunities to curtail antimicrobial therapy for presumed ventilator-associated pneumonia using the clinical pulmonary infection score.
abstract: BACKGROUND
  Early discontinuation of antimicrobial therapy for ventilator-associated pneumonia can reduce the emergence of antimicrobial resistance, the occurrence of adverse drug events, and the cost of therapy. Evidence suggests that discontinuation of therapy by day 3 may be appropriate for patients with a clinical pulmonary infection score of 6 or less at baseline and on day 3.
  
  
  OBJECTIVE
  To determine the proportion of patients eligible for antimicrobial discontinuation on day 3 and day 7 of therapy and to determine the proportion of eligible patients for whom antimicrobials were discontinued within these timeframes.
  
  
  METHODS
  A 6-month observational study was conducted from October 3, 2005, to March 31, 2006, in a 27-bed medical-surgical tertiary care intensive care unit. Clinical pharmacists attended daily rounds and prospectively identified patients for inclusion in the study. A study pharmacist retrospectively calculated clinical pulmonary infection scores. Other data were obtained from the quality-improvement database and patient health records for the intensive care unit.
  
  
  RESULTS
  Ninety-two patients were treated for ventilator-associated pneumonia during the study period, of whom 49 were included in the analysis. At day 3, 17 (35%) of the 49 patients were eligible for early discontinuation of antimicrobial therapy, but therapy was discontinued for only 2 (12%) of these 17 patients. At day 7, 10 (32%) of 31 patients were eligible for antimicrobial discontinuation, but therapy was discontinued for only 1 (10%) of these 10 patients.
  
  
  CONCLUSIONS
  A significant opportunity exists at the authors' institution to develop and implement an antimicrobial discontinuation policy that uses the clinical pulmonary infection score to guide antimicrobial use for patients with ventilator-associated pneumonia.
authors.affiliation: , BSc(Pharm), ACPR, PharmD, is a Critical Care Clinical Pharmacotherapeutic Specialist with the Clinical Services Unit - Pharmaceutical Sciences, Vancouver General Hospital, and is a Clinical Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia.
authors.forename: Sean K
authors.initials: SK
authors.lastname: Gorman
authors.forename: Lynne-Michelle M
authors.initials: LM
authors.lastname: Stewart
authors.forename: Richard S
authors.initials: RS
authors.lastname: Slavik
authors.forename: Jane
authors.initials: J
authors.lastname: de Lemos
authors.forename: Dean
authors.initials: D
authors.lastname: Chittock
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Dhingra
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Ronco
authors.forename: Harjinder
authors.initials: H
authors.lastname: Parwana