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The Impact of Changes in Antimicrobial Therapy on Patients With Ventilator-Associated Pneumonia

Winthrop University Hospital, Mineola, NY

PURPOSE: To assess the impact of frequent changes of antibiotics on the outcome of patients with Ventilator Associated Pneumonia (VAP)

METHODS: Retrospective chart review of 56 patients with VAP, divided into four groups, based on the frequency of changes in antimicrobial regimens, excluding de-escalation and simplification of therapy. The Clinical pulmonary infection score (CPIS) was used for the evaluation of pneumonia severity.

RESULTS: 19 Patients had no change of initial antibiotic regimen (Group 0); 8 and 19 patients, respectively had one and two changes (Group 1 and 2); and 10 patients had three or more changes (Group 3). There were no differences between the four groups with regard to age, gender, underlying disease, length of hospital stay, and the CPIS at diagnosis. The duration of ICU stay and mechanical ventilation increased with the frequency of changes. The adequacy of the treatment did not significantly differ among groups, but the rate of initial inadequate therapy tended to decrease as the frequency of changes increased (Group 0: 12.7%; Group 1: 8.1%; Group 2: 6.9%; Group 3: 5.9%.) Changes were based on the results of cultures in 37.5%, 15.8% and 14.0% of Group 1, 2 and 3, respectively. On the other hand, changes were for more often for uncertain reasons as the frequency of changes increased: 1.25%, 23.7% and 37.2% in Groups 1, 2 and 3, respectively. The crude mortality of Group 0 (21.1%) and Group 1 (25.0%) were similar. However, compared to Group 0, the mortality of Group 2 (57.9%) and Group 3 (80.0%) were higher (p = 0.04 and 0.004, respectively).

CONCLUSIONS: Frequent changes of antibiotics, often for uncertain reasons, were associated with increased mortality in patients with VAP.

CLINICAL IMPLICATIONS: If initial therapy is inadequate, there will be no increased mortality if antibiotics are changed only once.

DISCLOSURE: M. Kawabata, None.