Assessment of Local Antimicrobial Resistance Measures (ALARM) studies empiric ventilator-associated pneumonia (VAP) therapy.
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 CategoriesCategoryDrug/Class5Carbapenems4Cefepime3Extended spectrum penicillin2Fluoroquinolones1Other (therapies not falling into the previous categories)). The drug ranked highest in that combination categorized the combination therapy.
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 VAPOrganismCarbape-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).
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.
ALARM will provide local antibiograms to improve empiric therapy.
M.S. Niederman, Elan