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Escalation/De-escalation of Initial Empiric Ventilator-Associated Pneumonia Therapy: Interim Results from the Assessment of Local Antimicrobial Resistance Measures Study FREE TO VIEW

Marin H. Kollef, MD; Michael S. Niederman, MD*; Kenneth V. Leeper, MD; Lee E. Morrow, MD, MS; Antonio Anzueto, MD; Lisa Benz-Scott, PhD; Frank J. Rodino, MHS, PA
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Winthrop University Hospital, Mineola, NY


Chest. 2004;126(4_MeetingAbstracts):718S. doi:10.1378/chest.126.4_MeetingAbstracts.718S
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PURPOSE:  Assessment of Local Antimicrobial Resistance Measures (ALARM) studies empiric ventilator-associated pneumonia (VAP) therapy.

METHODS:  Gram-negative bacteria were isolated. Gram-positive bacteria and mixed flora were not considered. Therapies were categorized by activity spectrum (highest, 5; lowest, 1) (Table 1Table 1.

VAP Treatment Categories

CategoryDrug/Class5Carbapenems4Cefepime3Extended spectrum penicillin2Fluoroquinolones1Other (therapies not falling into the previous categories)). The drug ranked highest in that combination categorized the combination therapy.

RESULTS:  Organisms included (P. aeruginosa n=43, Klebsiella n=5, Acinetobacter n=5, E. coli n=8). Extended spectrum penicillin was used in 36%, cefepime 28%, and carbapenem 20% (Table 2Table 2:

Initial Therapy for VAP

OrganismCarbape-nemsCefe-pimeExt. Activity PenicillinQuino-lonesOtherTotalP. aeruginosa811182443klebsiella111115acinetobacter121105E. coli232018Total1217224661). Therapy remained unchanged in 46 cases (75%), escalated in 11 (18%), and de-escalated in 4 (7%) (Table 3). Escalation occurred in 24% (n=8) for P. aeruginosa (3 cases to carbapenem, 3 to cefepime, 1 to extended spectrum penicillin or quinolone).

CONCLUSION:  Escalation/de-escalation occurred in approximately 25% of gram-negative cases, de-escalation in 4 of 61 cases. Many patients could have been treated with narrower spectrum regimens. An opportunity exists to de-escalate more often.

CLINICAL IMPLICATIONS:  ALARM will provide local antibiograms to improve empiric therapy.

DISCLOSURE:  M.S. Niederman, Elan

Monday, October 25, 2004

10:30 AM- 12:15 PM




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