Healthcare-Associated Pneumonia in the ICU: Guideline-Concordant Antibiotics and Outcomes

• Published in: Journal of critical care 2016-08, Vol.36, p.265-271
• Main Authors: Attridge, Russell T., Pharm.D., M.Sc, Frei, Christopher R., Pharm.D., M.Sc, Pugh, Mary Jo V., Ph.D, Lawson, Kenneth A., Ph.D, Ryan, Laurajo, Pharm.D., M.Sc, Anzueto, Antonio, M.D, Metersky, Mark L., M.D, Restrepo, Marcos I., M.D., M.Sc, Mortensen, Eric M., M.D., M.Sc
• Format: Article
• Language: English
• Subjects: Critical Care
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.08.004

Abstract Purpose Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with healthcare-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an ICU with HCAP. Materials and Methods We performed a population-based cohort study of patients admitted to >150 hospitals in the U.S. Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving either GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model. Results A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). GC-HCAP patients had higher 30-day patient mortality compared to GC-CAP patients (34% vs. 22%, P < .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (OR, 95% CI; 1.67, 1.30–2.13), recent hospital admission (1.53, 1.15–2.02), and receipt of GC-HCAP therapy (1.51, 1.20–1.90). Conclusions Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.