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- Title
Defining Pathogen and Susceptibility Patterns for Early Versus Late Ventilator Associated Pneumonia in Trauma Patients to Guide Empiric Treatment Decisions.
- Authors
Alexander, Kaitlin M.; Davis, S. Noelle; Butts, C. Caleb; Morgan, John; Croft, Leah K.; Lee, Yann-leei L.; Kinnard, Christopher M.; Polite, Nathan M.; Mbaka, Maryann I.; Williams, Ashley Y.; Barrington, Robert A.; Audia, Jonathon P.; Simmons, Jon D.
- Abstract
Introduction: Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP. Methods: This retrospective cohort study included adult trauma patients with the diagnosis of VAP. The primary outcome was the presence of MRSA and/or P. aeruginosa in patients with early- and late-VAP. Secondary outcomes included the bacterial susceptibility of pathogens to methicillin, ampicillin/sulbactam, ceftriaxone, piperacillin/tazobactam, and cefepime. Intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days, and in-hospital mortality were also collected. Results: 164 patients met inclusion criteria, and 208 organisms (n = 90 early vs n = 118 late) were identified by respiratory culture. The incidence of MRSA and P. aeruginosa in early-VAP was 7.7% (7/90) and 5.6% (5/90), respectively. The susceptibility of bacteria causing early-VAP to ampicillin/sulbactam and ceftriaxone was 73.3% (66/90) and 83.3% (75/90), respectively. Ventilator-free days at 30 days was similar between groups (P =.649). Patients with late-VAP spent more time in the ICU (P =.040); however, in-hospital mortality was higher in the early-VAP group (P =.012). Conclusions: Ampicillin/sulbactam or ceftriaxone monotherapy did not provide reliable broad-spectrum coverage for early-VAP in our cohort. These findings highlight the importance of each institution performing a similar analysis to ensure adequate initial treatment of VAP.
- Subjects
VENTILATOR-associated pneumonia; PSEUDOMONAS aeruginosa infections; METHICILLIN-resistant staphylococcus aureus; LENGTH of stay in hospitals; INTENSIVE care units
- Publication
American Surgeon, 2023, Vol 89, Issue 11, p4536
- ISSN
0003-1348
- Publication type
Article
- DOI
10.1177/00031348221121539