Healthcare associated pneumonia in intensive care patients – optimal choice of initial empirical antimicrobial therapy: Results of a multicenter, observational study
Authors:
T. Herkeľ 1; R. Uvízl 1; M. Kolář 2
; M. Htoutou Sedláková 2; M. Adamus 1; L. Doubravská 1; T. Gabrhelík 3; V. Pudová 2; K. Langová 4
; R. Zazula 5
; T. Řezáč 5; M. Moravec 5
; P. Čermák 6; P. Ševčík 7,8; J. Stašek 9; A. Ševčíková 10; M. Hanslianová 10; Z. Turek 11; V. Černý 11,12; P. Paterová 13
Authors place of work:
Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc a Lékařská fakulta
Univerzity Palackého v Olomouci
1; Ústav mikrobiologie, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého v Olomouci
2; Anesteziologicko-resuscitační oddělení, Krajská nemocnice Tomáše Bati
3; Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého v Olomouci
4; Anesteziologicko-resuscitační klinika 1. lékařské fakulty Univerzity Karlovy v Praze a Thomayerovy
nemocnice Praha
5; Oddělení klinické mikrobiologie, Thomayerova nemocnice Praha
6; Katedra intenzivní medicíny, urgentní medicíny a forenzních oborů, Lékařská fakulta Ostravské univerzity
v Ostravě
7; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Ostrava
8; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Brno a Lékařská fakulta
Masarykovy univerzity Brno
9; Mikrobiologický ústav, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity Brno
10; Centrum pro výzkum a vývoj, Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice
Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové
11; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
12; Ústav klinické mikrobiologie, Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy
v Hradci Králové
13
Published in the journal:
Anest. intenziv. Med., 28, 2017, č. 3, s. 154-162
Category:
Intensive Care Medicine - Original Paper
Summary
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.
KEYWORDS:
nosocomial infections – hospital acquired pneumonia – initial empirical antibiotic therapy – epidemiology – pneumonia
Zdroje
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Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2017 Číslo 3
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