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    Antimicrobial Stewardship Opportunities in Critically Ill Patients with Gram-Negative Lower Respiratory Tract Infections: A Multicenter Cross-Sectional Analysis

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    Author
    Claeys, K.C.
    Zasowski, E.J.
    Trinh, T.D.
    Date
    2018
    Journal
    Infectious Diseases and Therapy
    Publisher
    Springer Healthcare
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1007/s40121-017-0179-5
    Abstract
    Introduction: Lower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs). Methods: This was a retrospective, observational, cross-sectional study of adult patients treated in ICUs at two large academic medical centers in metropolitan Detroit, Michigan, from October 2013 to October 2015. To meet the inclusion criteria, patients must have had CDC-defined LRTI caused by a GN pathogen during ICU stay. Microbiological assessment of available Pseudomonas aeruginosa isolates included minimum inhibitory concentrations for key antimicrobial agents. Results: Four hundred and seventy-two patients, primarily from the community (346, 73.3%), were treated in medical ICUs (272, 57.6%). Clinically defined pneumonia was common (264, 55.9%). Six hundred and nineteen GN organisms were identified from index respiratory cultures: P. aeruginosa was common (224, 36.2%), with 21.6% of these isolates being multidrug resistant. Cefepime (213, 45.1%) and piperacillin/tazobactam (174, 36.8%) were the most frequent empiric GN therapies. Empiric GN therapy was inappropriate in 44.6% of cases. Lack of in vitro susceptibility (80.1%) was the most common reason for inappropriateness. Patients with inappropriate empiric GN therapy had longer overall stay, which translated to a median total cost of care of $79,800 (interquartile range $48,775 to $129,600) versus $68,000 (interquartile range $38,400 to $116,175), p = 0.013. Clinical failure (31.5% vs 30.0%, p = 0.912) and in-hospital all-cause mortality (26.4% vs 25.9%, p = 0.814) were not different. Conclusion: Drug-resistant pathogens were frequently found and empiric GN therapy was inappropriate in nearly 50% of cases. Inappropriate therapy led to increased lengths of stay and was associated with higher costs of care. Copyright 2017, The Author(s).
    Sponsors
    This was an investigator-initiated study funded by Merck & Co. Inc. (Kennworth, NJ, USA)
    Keyword
    Acinetobacter baumannii
    Critically ill
    Enterobacteriaceae
    Klebsiella spp
    Pneumonia
    Pseudomonas aeruginosa
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043264858&doi=10.1007%2fs40121-017-0179-5&partnerID=40&md5=257a4f34b7b30ca87756b9f11b129011; http://hdl.handle.net/10713/9168
    ae974a485f413a2113503eed53cd6c53
    10.1007/s40121-017-0179-5
    Scopus Count
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