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Original Research: PNEUMONIA |

Using Local Microbiologic Data To Develop Institution-Specific Guidelines for the Treatment of Hospital-Acquired Pneumonia*

James R. Beardsley, PharmD; John C. Williamson, PharmD; James W. Johnson, PharmD; Christopher A. Ohl, MD; Tobi B. Karchmer, MD, MS; David L. Bowton, MD, FCCP
Author and Funding Information

*From the Department of Pharmacy (Drs. Beardsley, Williamson, and Johnson), Section of Infectious Diseases (Drs. Ohl and Karchmer), and Department of Anesthesiology, Section on Critical Care (Dr. Bowton), Wake Forest University Baptist Medical Center, Winston-Salem, NC.

Correspondence to: James R. Beardsley, PharmD, Department of Pharmacy, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157; e-mail: jbeardsl@wfubmc.edu



Chest. 2006;130(3):787-793. doi:10.1378/chest.130.3.787
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Background: While current guidelines recommend consideration of local microbiologic data when selecting empiric treatment for hospital-acquired pneumonia (HAP), few specifics of how to do this have been offered.

Methods: We conducted a retrospective analysis of HAP pathogens in 111 consecutive patients who acquired HAP during July to December 2004 and had a corresponding positive culture finding for a bacterial pathogen. These data were used to develop institution-specific guidelines.

Results: The most common bacteria identified were Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa, which were associated with 38%, 25%, and 19% of pneumonias, respectively. Susceptibility of Gram-negative bacteria to piperacillin-tazobactam and cefepime was 80% and 81%, respectively. The isolation of organisms resistant to piperacillin-tazobactam or cefepime was significantly more frequent in patients who had been hospitalized ≥ 10 days. Of Gram-negative isolates resistant to piperacillin-tazobactam or cefepime, ciprofloxacin was active against < 10%, while amikacin was active against > 80%. New treatment guidelines were developed that divided the American Thoracic Society/Infectious Diseases Society of America “late onset/risk of multidrug-resistant pathogens” group of patients into two subcategories: “early-late” pneumonias (< 10 days of hospitalization) and “late-late” pneumonias (≥ 10 days of hospitalization). Guideline-directed treatment regimens would be predicted to provide adequate initial therapy for > 90% of late-onset pneumonias at our institution.

Conclusions: Current guidelines suggest adding either an aminoglycoside or a fluoroquinolone to β-lactam therapy for empiric Gram-negative coverage. However, in our institution, adding ciprofloxacin would not appreciably enhance the likelihood of providing initial appropriate antibiotic coverage. This underscores the importance of employing a systematic analysis of local data when developing treatment guidelines.

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