Validation of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital-Acquired Pneumonia in the Intensive Care Unit

Background The 2005 guidelines of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital for managing hospital-acquired pneumonia classified patients according to time of onset and risk factors for potentially drug-resistant microorganisms to select the empirica...

Full description

Saved in:
Bibliographic Details
Published in:Clinical infectious diseases 2010-04, Vol.50 (7), p.945-952
Main Authors: Ferrer, Miquel, Liapikou, Adamantia, Valencia, Mauricio, Esperatti, Mariano, Theessen, Anna, Martinez, Jose Antonio, Mensa, Jose, Torres, Antoni
Format: Article
Language:English
Subjects:
Aged
Anti-Infective Agents - therapeutic use
Antimicrobials
ARTICLES AND COMMENTARIES
Bacteria - drug effects
Bacteria - isolation & purification
Biological and medical sciences
Chi-Square Distribution
Cross Infection - drug therapy
Cross Infection - microbiology
Drug resistance
Drug Resistance, Bacterial
Drug therapy
Etiology
Female
General aspects
Guideline Adherence
Human infectious diseases. Experimental studies and models
Humans
Infections
Infectious diseases
Intensive care
Intensive Care Units
Male
Medical sciences
Microbiology
Microorganisms
Middle Aged
Mitosporic Fungi - drug effects
Mitosporic Fungi - isolation & purification
Mortality
Pathogens
Patients
Pneumology
Pneumonia
Pneumonia, Bacterial - drug therapy
Pneumonia, Bacterial - microbiology
Predictive Value of Tests
Predisposing factors
Prospective Studies
Reproducibility of Results
Respiratory system : syndromes and miscellaneous diseases
Risk Factors
Statistics, Nonparametric
Ventilator associated pneumonia
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The 2005 guidelines of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital for managing hospital-acquired pneumonia classified patients according to time of onset and risk factors for potentially drug-resistant microorganisms to select the empirical antimicrobial treatment. We assessed the microbial prediction and validated the adequacy of these guidelines for antibiotic strategy. Methods We prospectively observed 276 patients with intensive care unit-acquired pneumonia. We classified patients into group 1 (early onset without risk factors for potentially drug-resistant microorganisms; 38 patients) and group 2 (late onset or risk factors for potentially drug-resistant microorganisms; 238 patients). We determined the accuracy of guidelines to predict causative microorganisms and the influence of guidelines adherence in patients' outcome. Results Microbial prediction was lower in group 1 than in group 2 (12 [50%] of 24 vs 119 [92%] of 129; P < .001) mainly because of potentially drug-resistant microorganisms in 10 patients (26%) from group 1. Guideline adherence was higher in group 2 (153 [64%] vs 7 [18%]; P < .001). Guideline adherence resulted in more treatment adequacy than did nonadherence (69 [83%] vs 45 [64%]; P = .013) and a trend toward better response to empirical treatment in group 2 only but did not influence mortality. Reclassifying patients according to the risk factors for potentially drug-resistant microorganisms of the former 1996 American Thoracic Society guidelines increased microbial prediction in group 1 to 21 (88%; P = .014); all except 1 patient with potentially drug-resistant microorganisms were correctly identified by these guidelines. Conclusions The 2005 guidelines predict potentially drug-resistant microorganisms worse than the 1996 guidelines. Adherence to guidelines resulted in more adequate treatment and a trend to a better clinical response in group 2, but it did not influence mortality.
ISSN:1058-4838
1537-6591
DOI:10.1086/651075