Validation Of The ATS/IDSA Guidelines For ICU-acquired Pneumonia

Abstract

: The 2005 ATS/IDSA guidelines for the management of hospital-acquired pneumonia (HAP) classified patients according to Background time-onset and risk factors for potentially-resistant microorganisms (PRM) in order to select the empiric antimicrobial treatment. We assessed the microbial prediction and validated the adequacy of these guidelines for antibiotic strategy.: We prospectively evaluated 276 cases of ICU-acquired pneumonia. We classified patients into Group 1 (early-onset without risk Methods factors for PRM, n=38) and Group 2 (late-onset or risk factors for PRM, n=238). We determined the accuracy of guidelines to predict causative microorganisms and the influence of guidelines adherence in patients' outcome. We also compared the 2005 ATS/IDSA guidelines with the former 1996 ATS guidelines for HAP.: A defined etiology was obtained in 153 (55%) cases, with similar rates of etiologic diagnosis, polymicrobial pneumonia and Results individual pathogens isolated among both groups. Microbial prediction was lower in Group 1 than Group 2 (12, 50% 119, 92%, p<0.001) vs mainly due to the isolation of PRM in 10 (26%) patients from Group 1. Guidelines adherence of physicians was higher in Group 2 (153, 64% 7, 18% in Group 1, p<0.001). Guidelines adherence resulted in more treatment adequacy than non-adherence (69, 83% 45, 64%, vs vs p=0.013) and a trend to better response to the empiric treatment in Group 2 only (98, 64% vs , 44, 52%, p=0.087), but didn't influence mortality. Reclassifying patients according to the risk factors for PRM of the former 1996 ATS guidelines increased microbial prediction in Group 1 to 21 (88%, p=0.014); all except 1 patient with PRM were correctly identified by these guidelines. Moreover, the association of guidelines adherence with more treatment adequacy and better response to the empiric treatment was more pronounced when the former 1996 ATS guidelines were applied.: The 2005 guidelines predict PRM worse than the 1996 guidelines and resulted in poor adherence of physicians in patients Conclusion from Group 1. Adherence to guidelines resulted in more adequate treatment and a trend to a better clinical response in Group 2, but didn't influence mortality. This abstract is funded by: CibeRes (CB06/06/0028)-ISCiii, 2009-SGR-911, ERS Fellowship, and IDIBAPS Am J Respir Crit Care Med

Do guidelines change outcomes in ventilator-associated pneumonia?

“…To the best of our knowledge, only one study [30 ] has validated microbial prediction and adequacy of antimicrobial treatment in the 2005 ATS/IDSA guidelines. A prospective, observational study was recently performed in 276 patients with clinical suspicion of ICU-acquired pneumonia.…”