Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria
Document Type
Article
Publication Title
Chest
Abstract
Objective: To identify predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia (VAP) attributed to potentially antibiotic-resistant Gram-negative bacteria (PARGNB) [Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia]. Design: A retrospective, single-center, observational cohort study. Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital. Patients: Adult patients requiring hospitalization with microbiologically confirmed VAP attributed to PARGNB. Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases. Measurements and main results: Seventy-six patients with VAP attributed to PARGNB were identified over a 5-year period. Nineteen patients (25.0%) died during hospitalization. Patients receiving their first dose of appropriate antibiotic therapy within 24 h of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy >24 h after BAL (17.2% vs 50.0%; p = 0.005). VAP due to Acinetobacter species was most often initially treated with an inappropriate antibiotic regimen, followed by S maltophilia and P aeruginosa (66.7% vs 33.3% vs 17.2%; p = 0.017). Overall, total hospitalization costs were statistically similar in patients initially treated with an inappropriate antibiotic regimen compared to an appropriate regimen ($68,597 ± $55,466 vs $86,644 ± $64,433; p = 0.390). Conclusions: These data suggest that inappropriate initial antibiotic therapy of microbiologically confirmed VAP attributed to PARGNB is associated with greater 30-day mortality. High rates of VAP attributed to antibiotic-resistant bacteria (eg, Acinetobacter species) may require changes in the local empiric antibiotic treatment of VAP in order to optimize the prescription of appropriate initial therapy. Copyright © 2008 by American College of Chest Physicians.
First Page
281
Last Page
287
DOI
10.1378/chest.08-1116
Publication Date
1-1-2008
Recommended Citation
Kollef, Katherine E.; Schramm, Garrett E.; Wills, Angela R.; Reichley, Richard M.; Micek, Scott T.; and Kollef, Marin H., "Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria" (2008). Pharmacy Practice Faculty Publications. 154.
https://doi.org/10.1378/chest.08-1116
https://collections.uhsp.edu/pharm-practice_pubs/154