TY - JOUR
T1 - Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia
AU - Iregui, Manuel
AU - Ward, Suzanne
AU - Sherman, Glenda
AU - Fraser, Victoria J.
AU - Kollef, Marin H.
N1 - Funding Information:
This work was supported in part by the Barnes-Jewish Hospital Foundation.
PY - 2002/7
Y1 - 2002/7
N2 - Study objectives: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP). Setting: Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated urban teaching hospital. Patients: One hundred seven consecutive patients receiving mechanical ventilation and antibiotic treatment for VAP. Interventions: Prospective patient surveillance and data collection. Measurements and results: All 107 patients eventually received treatment with an antibiotic regimen that was shown in vitro to be active against the bacterial pathogens isolated from their respiratory secretions. Thirty-three patients (30.8%) received antibiotic treatment that was delayed for ≥ 24 h after initially meeting diagnostic criteria for VAP. These patients were classified as receiving IDAAT. The most common reason for the administration of IDAAT was a delay in writing the antibiotic orders (n = 25; 75.8%). The mean time (± SD) interval from initially meeting the diagnostic criteria for VAP until the administration of antibiotic treatment was 28.6 ± 5.8 h among patients classified as receiving IDAAT, compared to 12.5 ± 4.2 h for all other patients (p < 0.001). Forty-four patients (41.1%) with VAP died during their hospitalization. Increasing APACHE (acute physiology and chronic health evaluation) II scores (adjusted odds ratio, 1.13; 95% confidence interval, 1.09 to 1.18; p < 0.001), presence of malignancy (adjusted odds ratio, 3.20; 95% confidence interval, 1.79 to 5.71; p = 0.044), and the administration of IDAAT (adjusted odds ratio, 7.68; 95% confidence interval, 4.50 to 13.09; p < 0.001) were identified as risk factors independently associated with hospital mortality by logistic regression analysis. Conclusion: These data suggest that patients classified as receiving IDAAT are at greater risk for hospital mortality. Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality.
AB - Study objectives: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP). Setting: Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated urban teaching hospital. Patients: One hundred seven consecutive patients receiving mechanical ventilation and antibiotic treatment for VAP. Interventions: Prospective patient surveillance and data collection. Measurements and results: All 107 patients eventually received treatment with an antibiotic regimen that was shown in vitro to be active against the bacterial pathogens isolated from their respiratory secretions. Thirty-three patients (30.8%) received antibiotic treatment that was delayed for ≥ 24 h after initially meeting diagnostic criteria for VAP. These patients were classified as receiving IDAAT. The most common reason for the administration of IDAAT was a delay in writing the antibiotic orders (n = 25; 75.8%). The mean time (± SD) interval from initially meeting the diagnostic criteria for VAP until the administration of antibiotic treatment was 28.6 ± 5.8 h among patients classified as receiving IDAAT, compared to 12.5 ± 4.2 h for all other patients (p < 0.001). Forty-four patients (41.1%) with VAP died during their hospitalization. Increasing APACHE (acute physiology and chronic health evaluation) II scores (adjusted odds ratio, 1.13; 95% confidence interval, 1.09 to 1.18; p < 0.001), presence of malignancy (adjusted odds ratio, 3.20; 95% confidence interval, 1.79 to 5.71; p = 0.044), and the administration of IDAAT (adjusted odds ratio, 7.68; 95% confidence interval, 4.50 to 13.09; p < 0.001) were identified as risk factors independently associated with hospital mortality by logistic regression analysis. Conclusion: These data suggest that patients classified as receiving IDAAT are at greater risk for hospital mortality. Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality.
KW - Antibiotics
KW - Intensive care
KW - Mechanical ventilation
KW - Outcomes
KW - Pneumonia
KW - Resistance
UR - http://www.scopus.com/inward/record.url?scp=0036304245&partnerID=8YFLogxK
U2 - 10.1378/chest.122.1.262
DO - 10.1378/chest.122.1.262
M3 - Article
C2 - 12114368
AN - SCOPUS:0036304245
SN - 0012-3692
VL - 122
SP - 262
EP - 268
JO - CHEST
JF - CHEST
IS - 1
ER -