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Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia

(2011) EUROPEAN RESPIRATORY JOURNAL. 37(6). p.1332-1339
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Abstract
The objectives of this study were to assess the determinants of empirical antibiotic choice, prescription patterns and outcomes in patients with hospital-acquired pneumonia (HAP)/ ventilator-associated pneumonia (VAP) in Europe. We performed a prospective, observational cohort study in 27 intensive care units (ICUs) from nine European countries. 100 consecutive patients on mechanical ventilation for HAP, on mechanical ventilation >48 h or with VAP were enrolled per ICU. Admission category, sickness severity and Acinetobacter spp. prevalence >10% in pneumonia episodes determined antibiotic empirical choice. Trauma patients were more often prescribed non-anti- Pseudomonas cephalosporins (OR 2.68, 95% CI 1.50-4.78). Surgical patients received less aminoglycosides (OR 0.26, 95% CI 0.14-0.49). A significant correlation (p<0.01) was found between Simplified Acute Physiology Score II score and carbapenem prescription. Basal Acinetobacter spp. prevalence >10% dramatically increased the prescription of carbapenems (OR 3.5, 95% CI 2.0-6.1) and colistin (OR 115.7, 95% CI 6.9-1,930.9). Appropriate empirical antibiotics decreased ICU length of stay by 6 days (26.3 +/- 19.8 days versus 32.8 +/- 29.4 days; p=0.04). The antibiotics that were prescribed most were carbapenems, piperacillin/tazobactam and quinolones. Median (interquartile range) duration of antibiotic therapy was 9 (6-12) days. Anti-methicillin- resistant Staphylococcus aureus agents were prescribed in 38.4% of VAP episodes. Admission category, sickness severity and basal Acinetobacter prevalence >10% in pneumonia episodes were the major determinants of antibiotic choice at the bedside. Across Europe, carbapenems were the antibiotic most prescribed for HAP/VAP.
Keywords
appropriate treatment, Antibiotic policy, combination therapy, hospital-acquired pneumonia, ventilator-associated pneumonia, INTENSIVE-CARE UNITS, HUMAN SEPTIC SHOCK, ANTIMICROBIAL RESISTANCE, ANTIBIOTIC USE, INFECTIONS, INITIATION, DIAGNOSIS, SURVIVAL, IMPACT

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Chicago
Rello, J, M Ulldemolins, T Lisboa, D. Koulenti, R Manez, I Martin-Loeches, Jan De Waele, et al. 2011. “Determinants of Prescription and Choice of Empirical Therapy for Hospital-acquired and Ventilator-associated Pneumonia.” European Respiratory Journal 37 (6): 1332–1339.
APA
Rello, J, Ulldemolins, M., Lisboa, T., Koulenti, D., Manez, R., Martin-Loeches, I., De Waele, J., et al. (2011). Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. EUROPEAN RESPIRATORY JOURNAL, 37(6), 1332–1339.
Vancouver
1.
Rello J, Ulldemolins M, Lisboa T, Koulenti D, Manez R, Martin-Loeches I, et al. Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. EUROPEAN RESPIRATORY JOURNAL. 2011;37(6):1332–9.
MLA
Rello, J, M Ulldemolins, T Lisboa, et al. “Determinants of Prescription and Choice of Empirical Therapy for Hospital-acquired and Ventilator-associated Pneumonia.” EUROPEAN RESPIRATORY JOURNAL 37.6 (2011): 1332–1339. Print.
@article{1986739,
  abstract     = {The objectives of this study were to assess the determinants of empirical antibiotic choice, prescription patterns and outcomes in patients with hospital-acquired pneumonia (HAP)/ ventilator-associated pneumonia (VAP) in Europe. 
We performed a prospective, observational cohort study in 27 intensive care units (ICUs) from nine European countries. 100 consecutive patients on mechanical ventilation for HAP, on mechanical ventilation {\textrangle}48 h or with VAP were enrolled per ICU. 
Admission category, sickness severity and Acinetobacter spp. prevalence {\textrangle}10\% in pneumonia episodes determined antibiotic empirical choice. Trauma patients were more often prescribed non-anti- Pseudomonas cephalosporins (OR 2.68, 95\% CI 1.50-4.78). Surgical patients received less aminoglycosides (OR 0.26, 95\% CI 0.14-0.49). A significant correlation (p{\textlangle}0.01) was found between Simplified Acute Physiology Score II score and carbapenem prescription. Basal Acinetobacter spp. prevalence {\textrangle}10\% dramatically increased the prescription of carbapenems (OR 3.5, 95\% CI 2.0-6.1) and colistin (OR 115.7, 95\% CI 6.9-1,930.9). Appropriate empirical antibiotics decreased ICU length of stay by 6 days (26.3 +/- 19.8 days versus 32.8 +/- 29.4 days; p=0.04). The antibiotics that were prescribed most were carbapenems, piperacillin/tazobactam and quinolones. Median (interquartile range) duration of antibiotic therapy was 9 (6-12) days. Anti-methicillin- resistant Staphylococcus aureus agents were prescribed in 38.4\% of VAP episodes. 
Admission category, sickness severity and basal Acinetobacter prevalence {\textrangle}10\% in pneumonia episodes were the major determinants of antibiotic choice at the bedside. Across Europe, carbapenems were the antibiotic most prescribed for HAP/VAP.},
  author       = {Rello, J and Ulldemolins, M and Lisboa, T and Koulenti, D. and Manez, R and Martin-Loeches, I and De Waele, Jan and Putensen, C and Guven, M and Deja, M and Diaz, E and EU-VAP/CAP study group, the and Blot, Stijn},
  issn         = {0903-1936},
  journal      = {EUROPEAN RESPIRATORY JOURNAL},
  keyword      = {appropriate treatment,Antibiotic policy,combination therapy,hospital-acquired pneumonia,ventilator-associated pneumonia,INTENSIVE-CARE UNITS,HUMAN SEPTIC SHOCK,ANTIMICROBIAL RESISTANCE,ANTIBIOTIC USE,INFECTIONS,INITIATION,DIAGNOSIS,SURVIVAL,IMPACT},
  language     = {eng},
  number       = {6},
  pages        = {1332--1339},
  title        = {Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia},
  url          = {http://dx.doi.org/10.1183/09031936.00093010},
  volume       = {37},
  year         = {2011},
}

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