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

2 Citations (Scopus)

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
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Pharmacists
Observational Studies
Anti-Bacterial Agents
Observation
Pneumonia
Sputum
Intensive Care Units
Patient Care

Keywords

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

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Improving antibiotic de-escalation in suspected ventilator-associated pneumonia : An observational study with a pharmacist-driven intervention. / Oxman, David A.; Adams, Christopher D.; Deluke, Gretchen; Philbrook, Lauren; Ireland, Peter; Mitani, Aya; Panizales, Christia; Frendl, Gyorgy; Rogers, Selwyn O.

In: Journal of Pharmacy Practice, Vol. 28, No. 5, 22.10.2015, p. 457-461.

Research output: Contribution to journalArticle

Oxman, DA, Adams, CD, Deluke, G, Philbrook, L, Ireland, P, Mitani, A, Panizales, C, Frendl, G & Rogers, SO 2015, 'Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: An observational study with a pharmacist-driven intervention', Journal of Pharmacy Practice, vol. 28, no. 5, pp. 457-461. https://doi.org/10.1177/0897190014527316
Oxman, David A. ; Adams, Christopher D. ; Deluke, Gretchen ; Philbrook, Lauren ; Ireland, Peter ; Mitani, Aya ; Panizales, Christia ; Frendl, Gyorgy ; Rogers, Selwyn O. / Improving antibiotic de-escalation in suspected ventilator-associated pneumonia : An observational study with a pharmacist-driven intervention. In: Journal of Pharmacy Practice. 2015 ; Vol. 28, No. 5. pp. 457-461.
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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.",
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