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Original Research: CRITICAL CARE MEDICINE |

Clinical Characteristics and Treatment Patterns Among Patients With Ventilator-Associated Pneumonia*

Marin H. Kollef, MD, FCCP; Lee E. Morrow, MD, FCCP; Michael S. Niederman, MD, FCCP; Kenneth V. Leeper, MD, FCCP; Antonio Anzueto, MD; Lisa Benz-Scott, BS; Frank J. Rodino, MS
Author and Funding Information

*From the Washington University School of Medicine (Dr. Kollef), St. Louis, MO; the Department of Pulmonary and Critical Care Medicine (Dr. Morrow), Creighton University, Omaha, NE; the Department of Internal Medicine (Dr. Niederman), Winthrop University Hospital, Mineola, NY; the Department of Pulmonary and Critical Care Medicine (Dr. Leeper), Emory University, Atlanta, GA; the Department of Pulmonary and Critical Care Medicine (Dr. Anzueto), University of Texas Health Sciences Center, Houston, TX; and Rodino Healthcare (Drs. Bullard and Rodino), Millburn, NJ.

Correspondence to: Marin H. Kollef, MD, FCCP, Campus Box 8052, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110; e-mail: mkollef@im.wustl.edu



Chest. 2006;129(5):1210-1218. doi:10.1378/chest.129.5.1210
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Study objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy.

Design: Prospective, observational, cohort study.

Setting: Twenty ICUs throughout the United States.

Patients: A total of 398 ICU patients meeting predefined criteria for suspected VAP.

Interventions: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes.

Measurements and results: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%), and cardiac complications (10.8%). The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 ± 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 ± 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2 days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; χ2 = 13.25; p = 0.001).

Conclusions: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants further clinical study.

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