Monday August 18, 2008
Choice of first dose of antibiotic makes difference !

A very important article from Barnes-Jewish Hospital, St. Louis, MO

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].

Patients: Adult patients requiring hospitalization with microbiologically confirmed VAP attributed to PARGNB.

Results: 76 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 hour of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy after 24 hour after BAL (17.2% vs 50.0%)
• 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%)

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.


Reference: Click to get abstract

Predictors of 30-Day Mortality and Hospital Costs in Patients With Ventilator-Associated Pneumonia Attributed to Potentially Antibiotic-Resistant Gram-Negative Bacteria - Chest. 2008; 134:281-287