Healthcare associated pneumonia in intensive care patients - optimal choice of initial empirical antimicrobial therapy: Results of a multicenter, observational study
Abstract
Objective: This study aimed to obtain recent epidemiological data on hospital-acquired pneumonia (HAP) in intensive care patients and to determine adequate empirical antimicrobial therapy. Setting: Department of Anaesthesiology, Resuscitation and Intensive Care Medicine.
Patients and methods: The prospective, multicenter, observational study assessed the spectrum of detected bacterial pathogens and their resistance to antimicrobial agents. It was compared with a reference approach to initial antibiotic therapy in early- and late-onset HAP.
Results: Total 317 patients were included in the study. The final patient sample comprised 201 subjects (159 males and 42 females) with a mean age of 59.9 years.
Total 260 valid samples of lower respiratory tract secretions were obtained. Early- and late-onset HAP was detected in 26 (12.9%) and 175 (87.1%) patients, respectively.
A total of 22 bacterial species were identified as etiological agents, with detection rates higher that 5% being noted in only 6 of them (Klebsiella pneumoniae 20.4%, Pseudomonas aeruginosa 20.0%, Escherichia coli 10.8%, Enterobacter spp. 8.1%, Staphylococcus aureus 6.2% and Burkholderia cepacia complex 5.8%). Gram-negative bacteria were most prevalent (86.1%).
Patients with early-onset HAP had considerably higher prevalence of strains of Staphylococcus aureus (26.9%) and Haemophilus influenzae (15.4%). In late-onset HAP, most dominant were the strains of Pseudomonas aeruginosa (21.8%) and Klebsiella pneumoniae (21.4%).
Most pathogens causing HAP (74.0%) were shown to have a unique restriction profile. Adequate initial empirical antibiotic therapy was noted in 59.7% of patients.
Conclusion: The reference approach to initial empirical antibiotic therapy of early- and late-onset HAP was consistent with the spectrum of bacterial pathogens and their susceptibility to antimicrobial agents.