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Updated: Jun 2, 2025
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Comparison of Multi-Drug Resistant Organisms Causing Early Ventilator-Associated Pneumonia in Three Geographically
Joseph M Swanson1, Peyton C Cole2, Julie E Farrar1
1Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA.
Abstract:
Introduction: It is unclear why differences in patient location change organisms causing ventilator-associated pneumonia (VAP). We investigated VAP organisms in three geographically separate trauma intensive care units (TICUs). Patients and Methods: A retrospective review of organisms causing VAP (bronchoalveolar lavage [BAL] performed ≤7 d after admission and growing ≥105 cfu/mL) in three geographically separate TICUs was conducted. Patients were treated by similar multidisciplinary teams and protocolized pathways. The primary outcome was the incidence of multi-drug resistant (MDR) VAP. Secondary outcomes were the incidence of inappropriate empiric antimicrobial therapy (IEAT) and the determination of risk factors for MDR VAP. Chi-squared, Kruskal-Wallis, and multi-variable logistic regression analyses were used accordingly. Results: In total, 271 patients were included: 142 in TICU-1, 63 in TICU-2, and 66 in TICU-3. The incidence of MDR VAP was similar across TICUs at 33.8%, 47.6%, and 39.4%, respectively (p = 0.17). Gram-negative MDRs were more prevalent in TICU-1 (70.8%) versus TICU-2 (60.0%) or TICU-3 (26.9%) (p = 0.001). Gram-positive MDRs were identified more in TICU-3 (73.1%) versus TICU-2 (43.3%) or TICU-1 (35.4%). IEAT did not differ by unit overall but was significantly greater for MDR gram-positive organisms in TICU-3 (70.4%) versus TICU-2 (44.8%) or TICU-1 (37.5%) (p = 0.02) and highest for MDR gram-negative organisms in TICU-1 (64.6%) versus TICU-2 (62.1%) or TICU-3 (55.8%) (p = 0.02). Multi-variable regression analyses revealed antibiotic days before BAL and kidney replacement therapy (KRT) as significant predictors of MDR VAP. Conclusions: Different TICU locations did not influence the overall incidence of MDR VAP, but differences in MDR organisms were observed. IEAT rates for both gram-positive and gram-negative organisms in different units may necessitate changes in empiric therapy. Antibiotic days prior to the BAL and KRT significantly increased the odds of early MDR VAP.
Insights
Geographic location did not affect the overall rate of multi-drug resistant ventilator-associated pneumonia (VAP). However, specific resistant organisms and inappropriate empiric antimicrobial therapy varied by unit, highlighting the need for tailored treatment strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in intensive care units.
- Understanding the microbial causes of VAP and factors influencing their prevalence is crucial for effective treatment.
- Geographic location of trauma intensive care units (TICUs) may influence the types of organisms causing VAP.
Purpose of the Study:
- To investigate the organisms causing VAP in three geographically separate TICUs.
- To determine the incidence of multi-drug resistant (MDR) VAP and inappropriate empiric antimicrobial therapy (IEAT).
- To identify risk factors associated with MDR VAP.
Main Methods:
- Retrospective review of VAP cases in three TICUs.
- Analysis of bronchoalveolar lavage (BAL) cultures from patients within 7 days of admission.
- Statistical analyses including Chi-squared, Kruskal-Wallis, and multi-variable logistic regression.
Main Results:
- Overall incidence of MDR VAP was similar across TICUs (33.8%–47.6%).
- Prevalence of Gram-negative MDRs was higher in TICU-1, while Gram-positive MDRs were more common in TICU-3.
- Inappropriate empiric antimicrobial therapy (IEAT) rates varied for specific MDR organisms across units. Antibiotic days before BAL and kidney replacement therapy (KRT) were significant predictors of MDR VAP.
Conclusions:
- While overall MDR VAP rates were consistent, specific organism profiles differed between TICUs.
- Variations in IEAT rates suggest a need for location-specific empiric antimicrobial therapy adjustments.
- Antibiotic exposure and KRT are key risk factors for developing MDR VAP.
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