title: Impact of pathogen-directed antimicrobial therapy for ventilator-associated pneumonia in trauma patients on charges and recurrence.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) represents one of the driving forces behind antibiotic use in the ICU. In a previous study, we established a defined algorithm for treatment of hospital-acquired VAP dictated by the causative pathogen. The purpose of the current study was to evaluate the impact of this algorithm for hospital-acquired VAP on recurrence and charges in trauma patients.
  
  
  METHODS
  Patients with VAP secondary to MRSA, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or Enterobacteriaceae during 5 years subsequent to the previous study were evaluated. All VAP were diagnosed using quantitative cultures of the bronchoalveolar lavage effluent. Duration of antimicrobial therapy was dictated by the causative pathogen. If microbiologic resolution, defined as <10(3) colony-forming units/mL, was achieved, therapy was stopped by day 10. The remainder received 14 days of therapy. Recurrence was defined as >10(5) colony-forming units/mL on subsequent bronchoalveolar lavage performed within 2 weeks after completion of appropriate therapy.
  
  
  RESULTS
  Five hundred and twenty-nine VAP episodes were identified in 381 patients. Overall recurrence was unchanged compared with the previous study (1.5% vs 2%; p = 0.3). There was a decrease in the number of bronchoalveolar lavages performed per patient compared with the previous study (1.6 vs 2.3; p = 0.24) and a reduction of 4.8 antibiotic days per VAP episode compared with the previous study. Both changes resulted in a cumulative reduction of $3,535.04 per patient, for a savings of $1.35 million during the study period.
  
  
  CONCLUSIONS
  Hospital-acquired VAP can be managed effectively by a defined course of therapy dictated by the causative pathogen. Adherence to an established algorithm simplified the management of VAP and contributed to a cumulative reduction in patient charges without impacting recurrence.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: John P
authors.initials: JP
authors.lastname: Sharpe
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: lmagnott@uthsc.edu.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Swanson
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: G Christopher
authors.initials: GC
authors.lastname: Wood
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents