Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia

Marin H. Kollef, Lee E. Morrow, Michael S. Niederman, Kenneth V. Leeper, Antonio Anzueto, Lisa Benz-Scott, Frank J. Rodino, Bullard

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Study objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. Design: Prospective, observational, cohort study. Setting: Twenty ICUs throughout the United States. Patients: A total of 398 ICU patients meeting predefined criteria for suspected VAP. Interventions: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. Measurements and results: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%),. and cardiac complications (10.8%). The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 ± 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%); Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 ± 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2. days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; χ2 = 13.25; p = 0.001). Conclusions: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants farther clinical study.

Original languageEnglish
Pages (from-to)1210-1218
Number of pages9
JournalChest
Volume129
Issue number5
DOIs
StatePublished - May 2006

Fingerprint

Ventilator-Associated Pneumonia
Therapeutics
Mortality
Institutional Practice
Monobactams
Handheld Computers
Dimercaprol
Postoperative Care
Methicillin-Resistant Staphylococcus aureus
Staphylococcus
Artificial Respiration
Pseudomonas aeruginosa
Nervous System
Observational Studies
Sepsis
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Kollef, M. H., Morrow, L. E., Niederman, M. S., Leeper, K. V., Anzueto, A., Benz-Scott, L., ... Bullard (2006). Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest, 129(5), 1210-1218. https://doi.org/10.1378/chest.129.5.1210

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. / Kollef, Marin H.; Morrow, Lee E.; Niederman, Michael S.; Leeper, Kenneth V.; Anzueto, Antonio; Benz-Scott, Lisa; Rodino, Frank J.; Bullard.

In: Chest, Vol. 129, No. 5, 05.2006, p. 1210-1218.

Research output: Contribution to journalArticle

Kollef, MH, Morrow, LE, Niederman, MS, Leeper, KV, Anzueto, A, Benz-Scott, L, Rodino, FJ & Bullard 2006, 'Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia', Chest, vol. 129, no. 5, pp. 1210-1218. https://doi.org/10.1378/chest.129.5.1210
Kollef, Marin H. ; Morrow, Lee E. ; Niederman, Michael S. ; Leeper, Kenneth V. ; Anzueto, Antonio ; Benz-Scott, Lisa ; Rodino, Frank J. ; Bullard. / Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. In: Chest. 2006 ; Vol. 129, No. 5. pp. 1210-1218.
@article{32a3516345c941f48706ffdfe27fbe4c,
title = "Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia",
abstract = "Study objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. Design: Prospective, observational, cohort study. Setting: Twenty ICUs throughout the United States. Patients: A total of 398 ICU patients meeting predefined criteria for suspected VAP. Interventions: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. Measurements and results: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6{\%}), neurologic conditions (13.3{\%}), sepsis (13.1{\%}),. and cardiac complications (10.8{\%}). The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 ± 6.9 days. Major pathogens were identified in 197 patients (49.5{\%}) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8{\%}); Pseudomonas aeruginosa (14.3{\%}), and other Staphylococcus species (8.8{\%}). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4{\%}) or a ureidopenicillin/monobactam combination (27.9{\%}). The mean duration of therapy was 11.8 ± 5.9 days. In the majority of cases (61.6{\%}), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3{\%} of cases, and deescalation occurred in 22.1{\%}. The overall mortality rate was 25.1{\%}, with a mean time to death of 16.2. days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0{\%}), compared with those experiencing therapy escalation (42.6{\%}) and those in whom therapy was neither escalated nor deescalated (23.7{\%}; χ2 = 13.25; p = 0.001). Conclusions: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants farther clinical study.",
author = "Kollef, {Marin H.} and Morrow, {Lee E.} and Niederman, {Michael S.} and Leeper, {Kenneth V.} and Antonio Anzueto and Lisa Benz-Scott and Rodino, {Frank J.} and Bullard",
year = "2006",
month = "5",
doi = "10.1378/chest.129.5.1210",
language = "English",
volume = "129",
pages = "1210--1218",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

TY - JOUR

T1 - Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia

AU - Kollef, Marin H.

AU - Morrow, Lee E.

AU - Niederman, Michael S.

AU - Leeper, Kenneth V.

AU - Anzueto, Antonio

AU - Benz-Scott, Lisa

AU - Rodino, Frank J.

AU - Bullard,

PY - 2006/5

Y1 - 2006/5

N2 - Study objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. Design: Prospective, observational, cohort study. Setting: Twenty ICUs throughout the United States. Patients: A total of 398 ICU patients meeting predefined criteria for suspected VAP. Interventions: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. Measurements and results: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%),. and cardiac complications (10.8%). The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 ± 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%); Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 ± 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2. days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; χ2 = 13.25; p = 0.001). Conclusions: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants farther clinical study.

AB - Study objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. Design: Prospective, observational, cohort study. Setting: Twenty ICUs throughout the United States. Patients: A total of 398 ICU patients meeting predefined criteria for suspected VAP. Interventions: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. Measurements and results: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%),. and cardiac complications (10.8%). The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 ± 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%); Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 ± 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2. days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; χ2 = 13.25; p = 0.001). Conclusions: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants farther clinical study.

UR - http://www.scopus.com/inward/record.url?scp=33646471520&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646471520&partnerID=8YFLogxK

U2 - 10.1378/chest.129.5.1210

DO - 10.1378/chest.129.5.1210

M3 - Article

VL - 129

SP - 1210

EP - 1218

JO - Chest

JF - Chest

SN - 0012-3692

IS - 5

ER -