Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-05-17T10:36:41.824Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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
Check for updates
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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.

References

Magill, SS, Edwards, JR, Bamberg, W et al. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
Freire, AT, Melnyk, V, Kim, MJ, et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 2010;68:140–151 Google ScholarPubMed
Kollef, MH, Chastre, J, Clavel, M, et al. A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin or ventilator-associated pneumonia. Crit Care 2012;16:R218.Google ScholarPubMed
Ramirez, J, Dartois, N, Gandjini, H, Yan, JL, Korth-Bradley, J, McGovern, PC. Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia. Antimicrob Agents Chemother 2013;57:1756–1762.Google ScholarPubMed
Réa-Neto, A, Niederman, M, Lobo, SM, et al. Efficacy and safety of doripenem versus piperacillin/tazobactam in nosocomial pneumonia: a randomized, open-label, multicenter study. Curr Med Res Opin 2008;24:2113–2126.Google ScholarPubMed
Chastre, J, Wunderink, R, Prokocimer, P, Lee, M, Kaniga, K, Friedland, I. Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multicenter, randomized study. Crit Care Med 2008;36:1089–1096.Google ScholarPubMed
Rubinstein, E, Lalani, T, Corey, GR, et al; ATTAIN Study Group. Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis 2011;52:31–40.Google ScholarPubMed
Wunderink, RG, Niederman, MS, Kollef, MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis 2012;54:621–629.Google ScholarPubMed
Wunderink, RG, Rello, J, Cammarata, SK, Croos-Dabrera, RV, Kollef, MH. Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 2003;124:1789–1797.Google ScholarPubMed
Zilberberg, MD, Nathanson, BH, Sulham, K, Fan, W, Shorr, AF. A novel algorithm to analyze epidemiology and outcomes of carbapenem resistance among patients with hospital-acquired and ventilator-associated pneumonia: a retrospective cohort study. Chest 2019;155:1119–1130 Google ScholarPubMed
Esperatti, M, Ferrer, M, Theessen, A, et al. Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 2010;182:1533–1539.Google ScholarPubMed
Vallecoccia, MS, Dominedo, C, Cutuli, SL, Martin-Loeches, I, Torres, A, De Pascale, G. Is ventilated hospital-acquired pneumonia a worse entity then ventilator-associated pneumonia? Eur Resp Rev 2020;29:200023.Google ScholarPubMed
Office for Human Research Protections. Human Subject regulations decision charts. US Department of Health and Human Services website. https://www.hhs.gov/ohrp/regulations-and-policy/decision-charts/index.html. Accessed February 3, 2021.Google Scholar
Zilberberg, MD, Nathanson, BH, Puzniak, LA, Shorr, AF. Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the US, 2012–2019. Crit Care Med 2022;50:460–468.Google Scholar
Zilberberg, MD, Nathanson, BH, Sulham, K, Fan, W, Shorr, AF. Development and validation of a bedside instrument to predict carbapenem resistance among gram-negative pathogens in complicated urinary tract infections. Infect Control Hosp Epidemiol 2018;39:1112–1114.Google ScholarPubMed
Zilberberg, MD, Ditch, K, Lawrence, K, Olesky, M, Shorr, MD. Carbapenem treatment and outcomes among patients with culture-positive complicated intra-abdominal infections in US hospitals: a retrospective cohort study. Open Forum Infect Dis 2019;6(12):ofz504.Google ScholarPubMed
Rothberg, MB, Pekow, PS, Priya, A, et al. Using highly detailed administrative data to predict pneumonia mortality. PLoS One 2014;9(1):e87382.Google ScholarPubMed
Rothberg, MB, Haessler, S, Lagu, T, et al. Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients? Infect Control Hosp Epidemiol 2014;35 suppl 3:S107–S115.Google ScholarPubMed
Haessler, S, Lindenauer, PK, Zilberberg, MD, et al. Blood cultures versus respiratory cultures: 2 different views of pneumonia. Clin Infect Dis 2020;71:1604–1612.Google ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1211–1301.Google Scholar
Quartin, AA, Scerpella, EG, Puttagunta, S, Kett, DH. A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1,184 patients from a large, international study. BMC Infect Dis 2013;13:561.Google Scholar
Cai, B, Echols, R, Corvino, F, et al. Carbapenem-resistance [sic] pathogens in HAP/VAP patients in US hospitals between 2010 and 2015. Eur Resp J 2018;52 suppl 62:PA2636.Google Scholar
Kalil, AC, Metersky, ML, Klompas, M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Disease Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:e61–e111.Google Scholar
US Department of Health and Human Services. Data summary of HAIs in the US: assessing progress 2006–2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html. Published 2017. Accessed March 3, 2022.Google Scholar
US Department of Health and Human Services. 2016 National and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Published 2017. Accessed March 3, 2022.Google Scholar
Kourtis, AP, Hatfield, K, Baggs, J, et al. Vital Signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus Bloodstream infections—United States. Morb Mortal Wkly Rep 2019;68:214–219.Google ScholarPubMed