Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay?

Elizabeth Knaak, Stephen J. Cavalieri, Gary N. Elsasser, Laurel C. Preheim, Alyssa Gonitzke, Christopher J. Destache

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Hospital-acquired pneumonia (HAP), ventilatorassociated pneumonia (VAP), and health careYassociated pneumonia (HCAP) are associated with substantial morbidity, mortality, and costs in the intensive care unit (ICU). The impact of antibiotic de-escalation on resource utilization, namely, length of stay (LOS) and cost of hospitalization, was investigated. Methods: A retrospective chart review was conducted from ICU admission of adult patients with a presumptive diagnosis of HAP, VAP, or HCAP in the 2009-2010 year. American Thoracic Society/Infectious Disease Society of America definitions for HAP, VAP, or HCAP were used. Eligible patients had blood and/or respiratory cultures collected before institution of empiric antibiotics. De-escalation required discontinuation of one or more empiric agent or change to narrower-spectrum antibiotic. The primary end point was the effect of antibiotic de-escalation on ICU LOS. Results: One hundred thirteen patients, representing 117 cases of HCAP, HAP, and VAP, met eligibility criteria. De-escalation was performed in 73 (62%) of pneumonias. De-escalated patients were more likely to be older (65.1 [SD, 16.8] vs 57.6 [SD, 19] years, P <0.05) and have cardiovascular disease (37% vs 14%, P <0.01). Intensive care unit LOS (9.3 [SD, 11.6] vs 13 [SD, 9.7] days, P = 0.069) was not significantly different; however, a significant difference in hospitalization costs ($38,016 [SD, 43,010] vs $55,217 [SD, 47,642], P <0.05) was found between the 2 groups. In-hospital mortality was significantly lower in de-escalated pneumonias (15% vs 39%, P <0.01). Conclusions: Although ICU LOS was not significantly different in this study, de-escalation was associated with significant reduction in resource utilization. In ICU patients with HCAP, HAP, or VAP, de-escalation affords an opportunity to improve antimicrobial stewardship and decrease resource utilization at no detriment to clinical outcome.

Original languageEnglish
Pages (from-to)172-176
Number of pages5
JournalInfectious Diseases in Clinical Practice
Volume21
Issue number3
DOIs
StatePublished - May 2013

Fingerprint

Intensive Care Units
Length of Stay
Pneumonia
Anti-Bacterial Agents
Health
Costs and Cost Analysis
Hospitalization
Patient Admission
Hospital Mortality
Communicable Diseases
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay? / Knaak, Elizabeth; Cavalieri, Stephen J.; Elsasser, Gary N.; Preheim, Laurel C.; Gonitzke, Alyssa; Destache, Christopher J.

In: Infectious Diseases in Clinical Practice, Vol. 21, No. 3, 05.2013, p. 172-176.

Research output: Contribution to journalArticle

Knaak, Elizabeth ; Cavalieri, Stephen J. ; Elsasser, Gary N. ; Preheim, Laurel C. ; Gonitzke, Alyssa ; Destache, Christopher J. / Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay?. In: Infectious Diseases in Clinical Practice. 2013 ; Vol. 21, No. 3. pp. 172-176.
@article{7bdb65aa263e42dabaf119d05d217b7a,
title = "Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay?",
abstract = "Background: Hospital-acquired pneumonia (HAP), ventilatorassociated pneumonia (VAP), and health careYassociated pneumonia (HCAP) are associated with substantial morbidity, mortality, and costs in the intensive care unit (ICU). The impact of antibiotic de-escalation on resource utilization, namely, length of stay (LOS) and cost of hospitalization, was investigated. Methods: A retrospective chart review was conducted from ICU admission of adult patients with a presumptive diagnosis of HAP, VAP, or HCAP in the 2009-2010 year. American Thoracic Society/Infectious Disease Society of America definitions for HAP, VAP, or HCAP were used. Eligible patients had blood and/or respiratory cultures collected before institution of empiric antibiotics. De-escalation required discontinuation of one or more empiric agent or change to narrower-spectrum antibiotic. The primary end point was the effect of antibiotic de-escalation on ICU LOS. Results: One hundred thirteen patients, representing 117 cases of HCAP, HAP, and VAP, met eligibility criteria. De-escalation was performed in 73 (62{\%}) of pneumonias. De-escalated patients were more likely to be older (65.1 [SD, 16.8] vs 57.6 [SD, 19] years, P <0.05) and have cardiovascular disease (37{\%} vs 14{\%}, P <0.01). Intensive care unit LOS (9.3 [SD, 11.6] vs 13 [SD, 9.7] days, P = 0.069) was not significantly different; however, a significant difference in hospitalization costs ($38,016 [SD, 43,010] vs $55,217 [SD, 47,642], P <0.05) was found between the 2 groups. In-hospital mortality was significantly lower in de-escalated pneumonias (15{\%} vs 39{\%}, P <0.01). Conclusions: Although ICU LOS was not significantly different in this study, de-escalation was associated with significant reduction in resource utilization. In ICU patients with HCAP, HAP, or VAP, de-escalation affords an opportunity to improve antimicrobial stewardship and decrease resource utilization at no detriment to clinical outcome.",
author = "Elizabeth Knaak and Cavalieri, {Stephen J.} and Elsasser, {Gary N.} and Preheim, {Laurel C.} and Alyssa Gonitzke and Destache, {Christopher J.}",
year = "2013",
month = "5",
doi = "10.1097/IPC.0b013e318279ee87",
language = "English",
volume = "21",
pages = "172--176",
journal = "Infectious Diseases in Clinical Practice",
issn = "1056-9103",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay?

AU - Knaak, Elizabeth

AU - Cavalieri, Stephen J.

AU - Elsasser, Gary N.

AU - Preheim, Laurel C.

AU - Gonitzke, Alyssa

AU - Destache, Christopher J.

PY - 2013/5

Y1 - 2013/5

N2 - Background: Hospital-acquired pneumonia (HAP), ventilatorassociated pneumonia (VAP), and health careYassociated pneumonia (HCAP) are associated with substantial morbidity, mortality, and costs in the intensive care unit (ICU). The impact of antibiotic de-escalation on resource utilization, namely, length of stay (LOS) and cost of hospitalization, was investigated. Methods: A retrospective chart review was conducted from ICU admission of adult patients with a presumptive diagnosis of HAP, VAP, or HCAP in the 2009-2010 year. American Thoracic Society/Infectious Disease Society of America definitions for HAP, VAP, or HCAP were used. Eligible patients had blood and/or respiratory cultures collected before institution of empiric antibiotics. De-escalation required discontinuation of one or more empiric agent or change to narrower-spectrum antibiotic. The primary end point was the effect of antibiotic de-escalation on ICU LOS. Results: One hundred thirteen patients, representing 117 cases of HCAP, HAP, and VAP, met eligibility criteria. De-escalation was performed in 73 (62%) of pneumonias. De-escalated patients were more likely to be older (65.1 [SD, 16.8] vs 57.6 [SD, 19] years, P <0.05) and have cardiovascular disease (37% vs 14%, P <0.01). Intensive care unit LOS (9.3 [SD, 11.6] vs 13 [SD, 9.7] days, P = 0.069) was not significantly different; however, a significant difference in hospitalization costs ($38,016 [SD, 43,010] vs $55,217 [SD, 47,642], P <0.05) was found between the 2 groups. In-hospital mortality was significantly lower in de-escalated pneumonias (15% vs 39%, P <0.01). Conclusions: Although ICU LOS was not significantly different in this study, de-escalation was associated with significant reduction in resource utilization. In ICU patients with HCAP, HAP, or VAP, de-escalation affords an opportunity to improve antimicrobial stewardship and decrease resource utilization at no detriment to clinical outcome.

AB - Background: Hospital-acquired pneumonia (HAP), ventilatorassociated pneumonia (VAP), and health careYassociated pneumonia (HCAP) are associated with substantial morbidity, mortality, and costs in the intensive care unit (ICU). The impact of antibiotic de-escalation on resource utilization, namely, length of stay (LOS) and cost of hospitalization, was investigated. Methods: A retrospective chart review was conducted from ICU admission of adult patients with a presumptive diagnosis of HAP, VAP, or HCAP in the 2009-2010 year. American Thoracic Society/Infectious Disease Society of America definitions for HAP, VAP, or HCAP were used. Eligible patients had blood and/or respiratory cultures collected before institution of empiric antibiotics. De-escalation required discontinuation of one or more empiric agent or change to narrower-spectrum antibiotic. The primary end point was the effect of antibiotic de-escalation on ICU LOS. Results: One hundred thirteen patients, representing 117 cases of HCAP, HAP, and VAP, met eligibility criteria. De-escalation was performed in 73 (62%) of pneumonias. De-escalated patients were more likely to be older (65.1 [SD, 16.8] vs 57.6 [SD, 19] years, P <0.05) and have cardiovascular disease (37% vs 14%, P <0.01). Intensive care unit LOS (9.3 [SD, 11.6] vs 13 [SD, 9.7] days, P = 0.069) was not significantly different; however, a significant difference in hospitalization costs ($38,016 [SD, 43,010] vs $55,217 [SD, 47,642], P <0.05) was found between the 2 groups. In-hospital mortality was significantly lower in de-escalated pneumonias (15% vs 39%, P <0.01). Conclusions: Although ICU LOS was not significantly different in this study, de-escalation was associated with significant reduction in resource utilization. In ICU patients with HCAP, HAP, or VAP, de-escalation affords an opportunity to improve antimicrobial stewardship and decrease resource utilization at no detriment to clinical outcome.

UR - http://www.scopus.com/inward/record.url?scp=84879107594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879107594&partnerID=8YFLogxK

U2 - 10.1097/IPC.0b013e318279ee87

DO - 10.1097/IPC.0b013e318279ee87

M3 - Article

AN - SCOPUS:84879107594

VL - 21

SP - 172

EP - 176

JO - Infectious Diseases in Clinical Practice

JF - Infectious Diseases in Clinical Practice

SN - 1056-9103

IS - 3

ER -