Descriptive analysis of ICU patients with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia at four academic medical centers

Introduction

We developed an ICU performance improvement project to evaluate patients with ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP), and healthcare-associated pneumonia (HCAP) using the 2005 American Thoracic Society/Infectious Diseases Society of America guidelines. Below is a descriptive analysis of the patients enrolled and their outcomes.

Methods

Data were collected prospectively. Patients were classified as VAP, HAP and HCAP. Antibiotics were chosen based on local antibiograms.

Results

The first 158 patients are reported (VAP n = 120, HAP n = 26 and HCAP n = 12). Patients often had comorbidities; diabetes (22%), cardiac (22%), respiratory (21%) and renal (16%). Microorganisms were identified in 78% of patients. One hundred and twenty-five patients received empiric therapy (ET). ET was compliant with the guidelines in 31% of these patients. De-escalation of antibiotic therapy occurred on day 3 in 75% (77/103) of candidates. Clinical improvement and/or cure were seen in 70% of patients. Superinfections developed in 37% of the patients. In patients requiring mechanical ventilatory support, the average days on the ventilator was 12 ± 17 days. Patients' average stay (days) in the ICU* and hospital* differed by group: VAP (17 ± 14 days, 23 ± 19 days), HAP (9 ± 10 days, 13 ± 13 days) and HCAP (11 ± 19 days, 22 ± 36 days), respectively. *Comparisons with P < 0.05. See Table 1.

Table 1 abstract P5

Conclusion

VAP, as compared with HAP and HCAP, had the highest severity of illness, mortality, and consumption of ICU and hospital resources. Published guidelines are not easily translated into daily practice.