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Antibiogram Surveillance to Determine Appropriate Initial Empiric Antibiotic Therapy for Ventilator-Associated
Andrew J Kerwin1, G Christopher Wood2, Saskya Byerly1
1Department of Surgery, Division of Trauma and Surgical Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Abstract:
Background: Our protocolized empiric antibiotic therapy for early (≤7 d) ventilator-associated pneumonia (VAP) and late (>7 d) VAP based on our local antibiogram leads to inappropriate empiric antibiotic therapy (IEAT) approximately 15% of the time. We reviewed our trauma intensive care unit (TICU) antibiogram to determine if sensitivity patterns were changing and warranted protocol adjustments. We hypothesized there would be no change in IEAT over time. Patients and Methods: TICU patients with VAP (bronchoalveolar lavage culture ≥100,000 CFU/mL) between 2017 and 2022 were reviewed. We reviewed the pathogens and sensitivity patterns to identify the IEAT percentage, and we reviewed changes in the rate of antimicrobial days per 1,000 days present for 2018-2022. Results: We noted an increase in IEAT beginning in 2017. In early VAP, the increase in IEAT was because of an increase in identification of gram-negative bacteria isolates (7%-24%), specifically an increase in Pseudomonas (3%-10%) and a decrease in Streptococcus sp. (32%-23%) and Haemophilus influenzae (20%-17%). In late VAP, the increase in IEAT was largely because of an increase in identification of Stenotrophomonas (3%-5%) and Acinetobacter (4%-10%). Antimicrobial use changed as pathogens and sensitivity changed. There were increases in rates per 1,000 days for cefazolin (11.9%), vancomycin (22.8%), cefepime (33.1%), and meropenem (424.7%), whereas there were decreases in rates per 1,000 days for ampicillin/sulbactam (-4.5%) and piperacillin/tazobactam (-9.5%). Conclusions: The change in organisms identified and the increase in IEAT highlight the importance of continuous antibiogram monitoring.
Insights
Antibiotic therapy for ventilator-associated pneumonia (VAP) is often inappropriate due to changing pathogen sensitivities. Continuous monitoring of local antibiograms is crucial for effective VAP treatment protocols.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Protocolized empiric antibiotic therapy for ventilator-associated pneumonia (VAP) is guided by local antibiograms.
- Inappropriate empiric antibiotic therapy (IEAT) for VAP occurs approximately 15% of the time.
- Changes in pathogen sensitivity patterns may necessitate adjustments to VAP treatment protocols.
Purpose of the Study:
- To review the trauma intensive care unit (TICU) antibiogram for changing sensitivity patterns.
- To determine if current VAP treatment protocols require adjustment based on evolving resistance.
- To evaluate trends in IEAT and antimicrobial use over time.
Main Methods:
- Retrospective review of TICU patients diagnosed with VAP between 2017 and 2022.
- Analysis of bronchoalveolar lavage cultures (≥100,000 CFU/mL) to identify pathogens and their sensitivities.
- Assessment of IEAT percentages and changes in antimicrobial days per 1,000 days present (2018-2022).
Main Results:
- An increasing trend in IEAT was observed starting in 2017.
- Early VAP showed increased gram-negative isolates (7%-24%), notably *Pseudomonas* (3%-10%), with decreased *Streptococcus* and *Haemophilus influenzae*.
- Late VAP demonstrated increased *Stenotrophomonas* (3%-5%) and *Acinetobacter* (4%-10%) isolates.
- Antimicrobial use shifted, with increased rates for cefazolin, vancomycin, cefepime, and meropenem, and decreased rates for ampicillin/sulbactam and piperacillin/tazobactam.
Conclusions:
- Shifting pathogen prevalence and increasing IEAT underscore the need for ongoing antibiogram surveillance.
- Local antibiogram data is essential for refining VAP empiric antibiotic therapy protocols.
- Continuous monitoring can guide timely adjustments to antimicrobial stewardship and treatment efficacy.
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