Healthcare-Associated Pneumonia in the ICU: Guideline-Concordant Antibiotics and Outcome

Attridge, R.T. et al. Journal of Critical Care | Published online: August 11, 2016

L0075034 An intensive care unit in a hospital.
Image source: Robert Priseman – Wellcome Library // CC BY-NC-ND 4.0

Purpose: Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with healthcare-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an ICU with HCAP.

Materials and Methods: We performed a population-based cohort study of patients admitted to >150 hospitals in the U.S. Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving either GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model.

Results: A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). GC-HCAP patients had higher 30-day patient mortality compared to GC-CAP patients (34% vs. 22%, P < .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (OR, 95% CI; 1.67, 1.30–2.13), recent hospital admission (1.53, 1.15–2.02), and receipt of GC-HCAP therapy (1.51, 1.20–1.90).

Conclusions: Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.

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Prevention of ventilator-associated pneumonia: Use of the care bundle approach

Alcan, A.O. et al. American Journal of Infection Control. Published online: 4 July 2016

Highlights

  • Ventilator-associated pneumonia is one of the most common nosocomial infections for critical care patients.
  • This study investigates the effect of using the care bundle on ventilator-associated pneumonia rates.
  • Implementation of the care bundle through nurse education is effective at reducing the rate of ventilator-associated pneumonia.

B0007348 Streptococcus pneumoniae
Image source: Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0 

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae

Background: The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study.

Methods: The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated.

Results: The nurses’ VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education.

Conclusion: VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.

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The critical care nurse work environment, physician staffing, and risk for ventilator-associated pneumonia

Costa, D.K. et al. American Journal of Infection Control. Published online: 12 May 2016

11556-2We examined the relationship between intensivist physician staffing, nurse work environment, and ventilator-associated pneumonia (VAP) in 25 intensive care units. We found a significant interaction between the nurse work environment, intensivist physician staffing, and VAP. Future work may need to focus on fostering organizational collaboration between nursing and medicine to leverage skills of both clinician groups to reduce risk for VAP in critically ill patients.

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Community-acquired pneumonia

The Lancet: Published Online, 12 August 2015

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide.

Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed.

Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria.

New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising.

Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events.

Studies are needed that focus on the long-term management of pneumonia.

via Community-acquired pneumonia – The Lancet.