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Microbiology, empiric therapy and its impact on the outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2014–2019

Published online by Cambridge University Press:  24 March 2022

Marya D. Zilberberg Open the ORCID record for Marya D. Zilberberg [Opens in a new window] ,
Brian H. Nathanson ,
Laura A. Puzniak  and
Andrew F. Shorr
Marya D. Zilberberg*
Affiliation:
EviMed Research Group, Goshen, Massachusetts
Brian H. Nathanson
Affiliation:
OptiStatim, Longmeadow, Massachusetts
Laura A. Puzniak
Affiliation:
Merck & Company, Kenilworth, New Jersey
Andrew F. Shorr*
Affiliation:
Washington Hospital Center, Washington, DC
*
Author for correspondence: Marya Zilberberg, MD, MPH, EviMed Research Group, PO Box 303, Goshen, MA 01032. E-mail: evimedgroup@gmail.com.
Andrew Shorr, MD, MPH, MBA, 110 Irving St NW, Washington, DC 20010. E-mail: Andrew.Shorr@gmail.com
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Abstract

Objective:

To explore whether microbiology profiles and the impact of inappropriate empiric treatment differ in the setting of hospital-acquired bacterial pneumonia that requires subsequent mechanical ventilation (vHABP) versus one that does not (nvHABP) versus ventilator-associated bacterial pneumonia (VABP).

Design:

Multicenter retrospective cohort study within Premier Research database, 2014–2019.

Methods:

We identified cases based on a previously published International Classification of Disease, Ninth Revision/Tenth Revision Clinical Modification (ICD-9/ICD-10-CM) algorithm, and we compared the 3 groups with respect to the bacterial pathogens isolated from their blood, sputum, or lower airway samples, and their respective rates of exposure to inappropriate empiric treatment. Using regression modeling we computed the effect of inappropriate empiric treatment on outcomes.

Results:

Among 17,819 patients who met enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. S. aureus (majority methicillin-susceptible) was the most frequently isolated organism, followed P. aeruginosa, K. pneumoniae, and E. coli with variations across the conditions. Rates of carbapenem resistance were highest in VABP (9.1%) and to third-generation cephalosporins in vHABP (14.9%). Patients with nvHABP were most likely to receive inappropriate empiric treatment (8.5%). Although inappropriate empiric treatment was associated with an increase in adjusted postinfection-onset hospital length of stay (2.3 days) and cost ($12,142), its greatest magnitude was in the nvHABP group (4.9 days, $13,147).

Conclusions:

Substantial microbiologic differences exist among populations who suffer nvHABP, vHABP, and VABP, and inappropriate empiric treatment significantly worsens utilization outcomes. Given the moderate rates of carbapenem resistance and third-generation cephalosporin resistance, all patients require empiric coverage for a range of bacteria, including those targeting extended-spectrum β-lactamase and carbapenem resistance where appropriate.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 3 , March 2022 , pp. 277 - 283
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Copyright
© Merck & Co., Inc., Kenilworth, NJ, USA and its affiliates and the Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Portions of these data were presented at the ECCMID 2021 annual conference on July 9–12, 2021, in Vienna, Austria. Descriptive epidemiology and outcomes without detailed microbiology and treatment are included in “Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the US, 2012–2019,” by MD Zilberberg, BH Nathanson, LA Puzniak, and AF Shorr in Critical Care Medicine 2022;50:460–468.

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