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Updated: Feb 3, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Antimicrobial prescription patterns and ventilator associated pneumonia: findings from a 10-site prospective audit
Rosalind M Elliott1,2, Anthony R Burrell3, Peter W Harrigan4
1University of Technology Sydney, Broadway, NSW, 2007, Australia. Rosalind.Elliott@health.gov.nsw.au.
Objective:
To examine anti-microbial prescribing practices associated with ventilator-associated pneumonia from data gathered during an audit of practice and outcomes in intensive care units (ICUs) in a previously published study.
Results:
The patient sample of 169 was 65% male with an average age of 59.7 years, a mean APACHE II score of 20.6, and a median ICU stay of 11 days. While ventilator-associated pneumonia was identified using a specific 4-item checklist in 29 patients, agreement between the checklist and independent physician diagnosis was only 17%. Sputum microbe culture reporting was sparse. Approximately 75% of the sample was administered an antimicrobial (main indications: lung infection [54%] and prophylaxis [11%]). No clinical justification was documented for 20% of prescriptions. Piperacillin/tazobactam was most frequently prescribed (1/3rd of all antimicrobial prescriptions) with about half of those for prophylaxis. Variations in prescribing practices were identified, including apparent gaps in antimicrobial stewardship; particularly in relation to prescribing for prophylaxis and therapy de-escalation. Sputum microbe culture reports for VAP did not appear to contribute to prescribing decisions but physician suspicion of lung infection and empiric therapy rather than ventilator-associated pneumonia criteria and guideline concordance.
Insights
Antimicrobial prescribing for ventilator-associated pneumonia (VAP) in ICUs showed significant variation, with limited use of diagnostic criteria and stewardship. Prescriptions often lacked documented justification, highlighting areas for improved antimicrobial stewardship.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Pharmacy
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in intensive care units (ICUs).
- Antimicrobial prescribing practices for VAP are crucial for patient outcomes and antimicrobial stewardship.
- Previous studies have highlighted variations in VAP management.
Purpose of the Study:
- To audit and analyze antimicrobial prescribing practices for patients with suspected or confirmed VAP in ICUs.
- To assess the concordance between diagnostic criteria, physician diagnosis, and antimicrobial use.
- To identify gaps in antimicrobial stewardship related to VAP treatment.
Main Methods:
- Retrospective audit of patient data from a previously published ICU study.
- Analysis of antimicrobial prescriptions, indications, and documented justifications.
- Comparison of VAP diagnosis using a checklist versus independent physician assessment.
- Evaluation of sputum microbe culture reporting and its influence on prescribing.
Main Results:
- Of 169 patients, 75% received antimicrobials, primarily for lung infection or prophylaxis.
- Clinical justification was missing for 20% of antimicrobial prescriptions.
- Piperacillin/tazobactam was the most common agent, frequently used for prophylaxis.
- Agreement between VAP checklist and physician diagnosis was low (17%).
- Sputum culture results did not appear to guide prescribing decisions.
Conclusions:
- Significant variations exist in antimicrobial prescribing for VAP, with limited adherence to diagnostic criteria and guidelines.
- Antimicrobial stewardship requires improvement, particularly concerning prophylaxis and de-escalation of therapy.
- Prescribing decisions were often based on clinical suspicion rather than objective VAP criteria.
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