Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia
Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases.
Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007.
Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases.
Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends.
Keywords: empirical therapy; hospital acquired pneumonia.
Butler JC, McNeil MM. Guideline for prevention of
nosocomial pneumonia. The Hospital Infection Control
Practices Advisory Committee, Centers for Disease
Control and Prevention. Infect Control Hosp Epidemiol.
2. American Thoracic Society. Guidelines for the management
of adults with hospital-acquired, ventilator-associated, and
healthcare-associated pneumonia. Am J Respir Crit Care
3. Swanson JM, Wells DL. Empirical Antibiotic Therapy for
Ventilator-Associated Pneumonia. Antibiotics [Internet].
2013 17 June 2015; 2:[339-51 pp.].
4. Borer A, Saidel-Odes L, Riesenberg K, et al. Attributable
mortality rate for carbapenem-resistant Klebsiella
pneumoniaebacteremia. Infect Control Hosp Epidemiol
5. CDC/NHSN Surveillance Definitions for Specific Types of
Infections. Centers for Disease Control and Prevention 2014.
6. Magiorakos AP, Srinivasan A, Carey RB, Carmeli
Y, Falagas ME, Giske CG, et al. Multidrug-resistant,
extensively drug-resistant and pandrug-resistant bacteria:
an international expert proposal for interim standard
definitions for acquired resistance. Clin Microbiol Infect.
7. CLSI. Clinical laboratory Standard institute, performance
guidelines for antimicrobial susceptibility testing, twenty
second informational supplement. 2012(M100).
8. Teixeira PJ, Seligman R, Hertz FT, Cruz DB, Fachel JM.
Inadequate treatment of ventilator-associated pneumonia:
risk factors and impact on outcomes. J Hosp Infect.
9. Piskin N, Aydemir H, Oztoprak N, Akduman D, Comert
F, Kokturk F, et al. Inadequate treatment of ventilatorassociated
and hospital-acquired pneumonia: risk factors and
impact on outcomes. BMC Infect Dis. 2012;12(268):1471-2334.
10. Alvarez-Lerma F. Modification of empiric antibiotic
treatment in patients with pneumonia acquired in the
intensive care unit. ICU-Acquired Pneumonia Study Group.
Intensive Care Med. 1996;22(5):387-94.
11. Werarak P, Kiratisin P, Thamlikitkul V. Hospital-acquired
pneumonia and ventilator-associated pneumonia in
adults at Siriraj Hospital: etiology, clinical outcomes, and
impact of antimicrobial resistance. J Med Assoc Thai.
12. Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N,
Khilnani GC, et al. Guidelines for diagnosis and management
of community- and hospital-acquired pneumonia in
adults: Joint ICS/NCCP(I) recommendations. Lung India.
13. Rello J, Ulldemolins M, Lisboa T, Koulenti D, Manez
R, Martin-Loeches I, et al. Determinants of prescription
and choice of empirical therapy for hospital-acquired
and ventilator-associated pneumonia. Eur Respir J.
14. Quartin AA, Scerpella EG, Puttagunta S, Kett DH. A
comparison of microbiology and demographics among
patients with healthcare-associated, hospital-acquired, and
ventilator-associated pneumonia: a retrospective analysis of
1184 patients from a large, international study. BMC Infect
15. Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija
SC. Ventilator-associated pneumonia in a tertiary care
hospital in India: role of multi-drug resistant pathogens. J
Infect Dev Ctries. 2010;4(4):218-25.
16. Merchant M, Karnad DR, Kanbur AA. Incidence of
nosocomial pneumonia in a medical intensive care unit
and general medical ward patients in a public hospital in
Bombay, India. J Hosp Infect. 1998;39(2):143-8.
17. Reechaipichitkul W, Phondongnok S, Bourpoern J, Chaimanee
P. Causative agents and resistance among hospital-acquired
and ventilator-associated pneumonia patients at Srinagarind
Hospital, northeastern Thailand. Southeast Asian J Trop
Med Public Health. 2013;44(3):490-502.
18. Zhao T, Liu Y, Cao B, Wang H, Chen L, She D, et al.
Prospective multicenter study of pathogen distributions in
early-onset and late-onset hospital-acquired pneumonia in
china. Antimicrob Agents Chemother. 2013;57(12):6404-5.
19. Falagas ME, Rafailidis PI. Colistin in Ventilator-Associated
Pneumonia. Clinical Infectious diseases. 2012;54(5):681-3.
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