Pharmacodynamic-based clinical pathway for empiric antibiotic choice in patients with ventilator-associated pneumonia |
| |
Authors: | Anthony M. Nicasio Kathryn J. Eagye David P. Nicolau Eric Shore Marc Palter Judith Pepe Joseph L. Kuti |
| |
Affiliation: | 1. Center for Antiinfective Research and Development, Hartford Hospital, Hartford, CT 06102, USA;2. Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA;3. Division of Pulmonary/Critical Care, Hartford Hospital, Hartford, CT, USA;4. Division of Neurosurgery/Critical Care, Hartford Hospital, Hartford, CT, USA;5. Division of Surgery/Critical Care, Hartford Hospital, Hartford, CT, USA;6. University of Connecticut, School of Medicine, Farmington, CT 06030, USA |
| |
Abstract: | BackgroundBecause of the high frequency of multidrug resistant bacteria in our intensive care units (ICUs), we implemented a ventilator-associated pneumonia (VAP) clinical pathway based on unit-specific minimum inhibitory concentration (MIC) distributions and pharmacodynamic modeling in 3 of our ICUs.MethodsThis was a prospective, observational evaluation with a historical control group in adult patients (n = 168) who met clinical and radiologic criteria for VAP. Monte Carlo simulation was used to determine antibiotic regimens having the greatest likelihood of achieving bactericidal exposures against Pseudomonas aeruginosa. Antibiotic regimens were incorporated into an ICU-specific computerized clinical pathway as empiric agents of choice.ResultsPharmacodynamic modeling found 3-hour infusions of cefepime 2 g every 8 hours or meropenem 2 g every 8 hours plus tobramycin and vancomycin would provide the greatest probability of empirically treating VAP in these ICUs. Infection-related mortality was reduced by 69% (8.5% vs 21.6%; P = .029), infection-related length of stay was shorter (11.7 ± 8.1 vs 26.1 ± 18.5; P < .001), and fewer superinfections were observed in patients treated on the pathway. A number of patients with nonsusceptible P aeruginosa were successfully treated with high-dose, 3-hour infusion regimens.ConclusionsIn our ICUs where multidrug resistant bacteria are common, an approach considering ICU-specific antibiotic MICs coupled with pharmacodynamic dosing strategies resulted in improved outcomes and shorter duration of treatments. |
| |
Keywords: | Ventilator-associated pneumonia Antibiotics Pharmacodynamics ICU Resistance Mortality |
本文献已被 ScienceDirect 等数据库收录! |
|