Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Abstract

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

Incidence and Risk Factors of Delirium in the Intensive Care Unit: A Prospective Cohort

“…The results showed that patients with delirium were treated more with antibiotics than patients without delirium, which could lead to the reduced rate of VAP in the delirium group. Similar to our results, prior studies have reported that the clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors and bacterial pathogens and antibiotic resistance patterns [ 42 , 43 ].…”

Practical Comparison of the BioFire FilmArray Pneumonia Panel to Routine Diagnostic Methods and Potential Impact on Antimicrobial Stewardship in Adult Hospitalized Patients with Lower Respiratory Tract Infections

“…Based on these findings, broad-spectrum empirical antibiotic therapy consisting of 2 or 3 agents is recommended for patients with symptoms consistent with HAP or VAP until definitive laboratory results are available to inform targeted and specific therapy (3,7). As a result, it is estimated that up to 50% of antibiotics used in hospital intensive care units (ICUs) are prescribed to treat these infections (3,8). An emphasis of the current American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) guidelines for management of patients with HAP or VAP is to reduce exposure to broad-spectrum and unnecessary antibiotics by targeting therapy to treat the most likely pathogens based on patient risk factors and laboratory results (3).…”

Repositioning of endotracheal tube and risk of ventilator-associated pneumonia among adult patients: A matched case-control study

“…We acknowledge certain limitations of this study: we did not have information on certain risk factors for VAP such as using antibiotics and hence, these were not included in the analysis. [20] However, as with any observational studies, the effect of residual confounding in addition to unmeasured confounding cannot be eliminated. Furthermore, not all cases have four controls as in this analysis owing to matching without replacement, and we do not anticipate that will change the direction of our estimation.…”