Chest
ORIGINAL RESEARCHPNEUMONIAVentilator-Associated Pneumonia: Impact of Organisms on Clinical Resolution and Medical Resources Utilization
Section snippets
Study Participants
This prospective, observational study was performed in three ICUs. Each center has an infection control surveillance program with prospective recording of nosocomial infections. The first 15 consecutive patients with VAP due to MSSA, H influenzae, P aeruginosa, and MRSA who had received appropriate antibiotic therapy were included. Thirty consecutive patients with episodes of VAP due to P aeruginosa with IAT were also included in the study.
Potential exclusion criteria included death within 72
Results
Sixty VAP episodes with appropriate empirical antibiotic therapy were included in the study. As regards etiology, 15 episodes were due to methicillin- susceptible S aureus (polymicrobial, 1 episode), 15 episodes were due to susceptible P aeruginosa (polymicrobial, 5 episodes), 15 episodes were due to H influenzae (polymicrobial, 3 episodes), and 15 episodes were due to MRSA with appropriate antibiotic therapy, all of them monomicrobial. There were no significant differences in baseline
Discussion
The most important finding in this study is that MRSA VAP treated with appropriate therapy resolves more slowly than VAP due to H influenzae, MSSA, and P aeruginosa treated with appropriate therapy. In addition, the slow rate of resolution of MRSA is comparable to that of P aeruginosa when the latter organism is treated with inappropriate initial therapy. The delay in resolution for these organisms was associated with excess medical resource utilization.
Differences in the evolution of
ACKNOWLEDGMENT
We are indebted with Montse Olona, MD, for statistical advice and Mike Maudsley for editing of the English language.
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Presented in part at the 19th European Society of Intensive Care Medicine annual congress, Barcelona, Spain, September 25 to 27, 2006.
Supported in part by Centro Investigación Biomédica en Red de Enfermedades Respiratorias grants CB06/06/0036, FISS PI05/2410, and AGAUR 2005/SGR/920.
Dr. Rello has served in the speakers bureau or has been a consultant for Pfizer, Wyeth Pharmaceuticals, Arpida, Basilea, Johnson & Johnson, Intercell, AstraZeneca, Novartis, and Schering Plough; and he has received research grants from Lilly and Pfizer. Drs. Vidaur, Planas, Sierra, Dimopoulos, Ramirez, and Lisboa have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.