Document Detail


The pathogen of ventilator-associated pneumonia does not influence the mortality rate of surgical intensive care unit patients treated with a rotational antibiotic system.
MedLine Citation:
PMID:  20163258     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the leading causes of morbidity in critically ill surgical patients. Certain pathogens (e.g., methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa) have been associated with an excess mortality rate from sepsis in several studies, but not in the surgical setting specifically or when protocol-driven antibiotic therapy is administered. PURPOSE: We sought to determine which factors and, in particular, whether the individual pathogen affected the mortality rate in our surgical intensive care unit (ICU), where a rotational antibiotic system has been employed continuously since 1997. We hypothesized that the type of pathogen and illness severity were the primary influences on the mortality rate of patients with VAP. METHODS: A total of 198 consecutive patients from a university surgical ICU, with clinical signs of VAP confirmed by quantified isolation of significant numbers of a pathogen (> or =10(4) colony-forming units [cfu]/mL) from bronchoalveolar (BAL) fluid obtained by fiberoptic bronchoscopy, were identified prospectively from January 2001 to November 2004. The data collected were age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) III score, multiple organ dysfunction score, unit day of diagnosis, time (h) to antibiotic administration (TTA), appropriateness of initial therapy (AIT), unit and hospital length of stay, and mortality rate. Pathogens were classified as non-lactose-fermenting gram-negative bacilli (NGNB), lactose-fermenting gram-negative bacilli (LGNB), methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus, yeast, community-acquired pneumonia (e.g., Streptococcus pneumoniae), or other pathogens. Patients with a polymicrobial isolate were placed in the "other" category. RESULTS: The overall mortality rate was 32.3% vs. 55% as predicted by APACHE III normative data. The overall AIT was 92%. The mortality rate for NGNB infections was 35.6% vs. 29.4% for LGNB infections (p = NS). By logistic regression, neither TTA, AIT, nor pathogen influenced the mortality rate. CONCLUSIONS: The type of pathogen does not influence death in surgical ICU patients with VAP diagnosed rigorously and treated by a rotational antibiotic system. The high proportion of AIT as a result of the rotational antibiotic administration system optimizes bacterial killing and negates the impact of bacterial resistance, contributing to better outcomes.
Authors:
Soumitra R Eachempati; Lynn J Hydo; Jian Shou; Philip S Barie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical infections     Volume:  11     ISSN:  1557-8674     ISO Abbreviation:  Surg Infect (Larchmt)     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-18     Completed Date:  2010-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815642     Medline TA:  Surg Infect (Larchmt)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  13-20     Citation Subset:  IM    
Affiliation:
Department of Surgery, Weill Medical College of Cornell University, 525 E. 68th St., New York, NY 10021, USA. sre2003@med.cornell.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Bacterial Infections / drug therapy,  mortality*
Bronchoalveolar Lavage Fluid / microbiology
Drug Therapy / methods*
Female
Gram-Negative Bacteria / isolation & purification
Gram-Positive Bacteria / isolation & purification
Humans
Intensive Care
Male
Middle Aged
Mycoses / drug therapy,  mortality*
Pneumonia, Ventilator-Associated / drug therapy,  mortality*
Treatment Outcome
Yeasts / isolation & purification
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

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