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Microbiology of Ventilator–Associated Pneumonia Compared With That of Hospital-Acquired Pneumonia

Published online by Cambridge University Press:  02 January 2015

David J. Weber ,
William A. Rutala ,
Emily E. Sickbert-Bennett ,
Gregory P. Samsa ,
Vickie Brown  and
Michael S. Niederman
David J. Weber*
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
Gregory P. Samsa
Affiliation:
Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, North Carolina
Vickie Brown
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
Michael S. Niederman
Affiliation:
Winthrop University Hospital and State University of New York, Stony Brook, New York, New York
*
CB #7030, 130 Mason Farm Road, UNC at Chapel Hill, Chapel Hill, NC 27599-7030 ([email protected])
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Abstract

Objective.

Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in non-ventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.

Design.

Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.

Setting.

A tertiary care academic hospital.

Patients.

All patients admitted from 2000 through 2003.

Results.

A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 Patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% {Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).

Conclusions.

Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 825 - 831
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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