title: Assessment of the intensive care unit treatment of pneumonia at a veterans affairs facility.
abstract: BACKGROUND
  Pneumonia is a common cause of morbidity and mortality in the critically ill. Clinicians use a range of duration for antibiotic treatment from 7 to 14 days or longer. Failure to de-escalate antimicrobial therapy in a timely manner may lead to increased antimicrobial resistance, increased risk of side effects, and increased cost.
  
  
  OBJECTIVE
  To investigate potential methods to improve treatment of pneumonia for patients in 4 intensive care units (ICUs).
  
  
  METHODS
  A retrospective descriptive chart review was conducted at the Veterans Affairs North Texas Health Care System (VANTHCS). Veterans aged 18 to 90 years admitted to the ICU with a diagnosis of pneumonia were included. Descriptive statistics were used to interpret the data. Current management was reviewed to identify markers such as length of antibiotic therapy, ICU length of stay, and inpatient mortality. Secondary objectives included appropriateness and accuracy of the empiric regimen.
  
  
  RESULTS
  Of the 1,854 Veterans admitted, 107 met inclusion criteria. Antibiotic choices for positive cultures were appropriate in 45 out of 46 (98%) patients, with an average length of therapy of 8.6 ± 6.3 days. De-escalation of antibiotics based on sensitivity data occurred in 73% of positive cultures.
  
  
  CONCLUSIONS
  Pneumonia in the VANTHCS ICUs is initially treated with empiric antibiotics. Empiric antibiotic therapy for pneumonia was appropriate and accurate over this time period. Opportunities exist for de-escalation in patients with or without positive cultures. The procalcitonin assay is now being utilized at VANTHCS to optimize patient care.
authors.affiliation: Assistant Professor of Pharmacy, Wingate University School of Pharmacy , Wingate, North Carolina.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Griffiths
authors.affiliation: Associate Professor of Pharmacy, Texas Tech University Health Sciences Center, VA North Texas Healthcare System , Dallas, Texas.
authors.forename: Steven
authors.initials: S
authors.lastname: Pass
authors.affiliation: Chief, Pulmonary/Critical Care, VA North Texas Healthcare System , Dallas, Texas ; Professor, Internal Medicine, U.T. Southwestern Medical Center , Dallas, Texas.
authors.forename: W Claibe
authors.initials: WC
authors.lastname: Yarbrough
keywords: antibiotics; de-escalation; pneumonia