Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: An observational study with a pharmacist-driven intervention

David A. Oxman, Christopher D. Adams, Gretchen Deluke, Lauren Philbrook, Peter Ireland, Aya Mitani, Christia Panizales, Gyorgy Frendl, Selwyn O. Rogers

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Recommendations for treatment of ventilator-associated pneumonia (VAP) emphasize early empiric broad-spectrum antibiotics. However, appropriate antibiotic de-escalation is also critical for optimal patient care. Materials and Methods: We examined how often intensivists in our institution appropriately de-escalated antibiotics in cases of suspected VAP, and whether decision support by intensive care unit pharmacists could improve rates of antibiotic targeting and early antibiotic discontinuation in low-risk patients. Main Results: A total of 92 (observation phase = 50; intervention phase = 42) patients with suspected VAP were identified. During the observation phase, 39 cases yielded positive sputum cultures, but in only 23 (59%) were antibiotics targeted to culture results. This rate improved during the intervention phase when 29 (91%) of 32 cases with positive cultures were targeted (P value.003). There were 48 cases in which the risk of pneumonia was considered low. Of the 26 low-risk cases in the observation phase, 5 (19%) had antibiotics discontinued early versus 5 (23%) of the 22 cases in the intervention phase. Conclusions: Decision support by clinical pharmacists significantly improved rates of appropriate antibiotic targeting in cases of culture-positive suspected VAP but did not have a significant effect on early antibiotic discontinuation in patients at low risk of true pneumonia.

Original languageEnglish (US)
Pages (from-to)457-461
Number of pages5
JournalJournal of Pharmacy Practice
Volume28
Issue number5
DOIs
StatePublished - Oct 22 2015

Keywords

  • antibiotic de-escalation
  • critical care
  • pneumonia
  • ventilator-associated pneumonia

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Oxman, D. A., Adams, C. D., Deluke, G., Philbrook, L., Ireland, P., Mitani, A., Panizales, C., Frendl, G., & Rogers, S. O. (2015). Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: An observational study with a pharmacist-driven intervention. Journal of Pharmacy Practice, 28(5), 457-461. https://doi.org/10.1177/0897190014527316