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Influence of microbiological culture results on antibiotic choices for veterans with hospital-acquired pneumonia and ventilator-associated pneumonia

Published online by Cambridge University Press:  04 June 2021

Taissa A. Bej
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, Ohio
Robbie L. Christian
Affiliation:
Pharmacy Services, VA Northeast Ohio Healthcare System, Cleveland, Ohio
Sharanie V. Sims
Affiliation:
Pharmacy Services, VA Northeast Ohio Healthcare System, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, Ohio Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sunah Song
Affiliation:
Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
Ukwen C. Akpoji
Affiliation:
Pharmacy Services, VA Northeast Ohio Healthcare System, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, Ohio Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Departments of Pathology, Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio
Federico Perez*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, Ohio Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio
Robin L. P. Jump*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, Ohio Division of Infectious Diseases & HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Author for correspondence: Robin L. P. Jump, E-mail: robin.jump@va.gov. Or Federico Perez, E-mail: federico.perez@va.gov
Author for correspondence: Robin L. P. Jump, E-mail: robin.jump@va.gov. Or Federico Perez, E-mail: federico.perez@va.gov

Abstract

Objective:

We examined the impact of microbiological results from respiratory samples on choice of antibiotic therapy in patients treated for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).

Design:

Four-year retrospective study.

Setting:

Veterans’ Health Administration (VHA).

Patients:

VHA patients hospitalized with HAP or VAP and with respiratory cultures between October 1, 2014, and September 30, 2018.

Interventions:

We compared patients with positive and negative respiratory culture results, assessing changes in antibiotic class and Antibiotic Spectrum Index (ASI) from the day of sample collection (day 0) through day 7.

Results:

Between October 1, 2014, and September 30, 2018, we identified 5,086 patients with HAP/VAP: 2,952 with positive culture results and 2,134 with negative culture results. All-cause 30-day mortality was 21% for both groups. The mean time from respiratory sample receipt in the laboratory to final respiratory culture result was longer for those with positive (2.9 ± 1.3 days) compared to negative results (2.5 ± 1.3 days; P < .001). The most common pathogens were Staphylococcus aureus and Pseudomonas aeruginosa. Vancomycin and β-lactam/β-lactamase inhibitors were the most commonly prescribed agents. The decrease in the median ASI from 13 to 8 between days 0 and 6 was similar among patients with positive and negative respiratory cultures. Patients with negative cultures were more likely to be off antibiotics from day 3 onward.

Conclusions:

The results of respiratory cultures had only a small influence on antibiotics used during the treatment of HAP/VAP. The decrease in ASI for both groups suggests the integration of antibiotic stewardship principles, including de-escalation, into the care of patients with HAP/VAP.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

Present affiliation: Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana

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Supplementary material: File

Bej et al. supplementary material

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