Anest. intenziv. Med. 2017;28(3):154-162

Healthcare associated pneumonia in intensive care patients - optimal choice of initial empirical antimicrobial therapy: Results of a multicenter, observational studyIntensive Care Medicine - Original Paper

T. Herkeľ¹, R. Uvízl^1,*, M. Kolář², M. Htoutou Sedláková², M. Adamus¹, L. Doubravská¹, T. Gabrhelík³, V. Pudová², K. Langová⁴, R. Zazula⁵, T. Řezáč⁵, M. Moravec⁵, P. Čermák⁶, P. Ševčík^7,8, J. Stašek⁹, A. Ševčíková¹⁰, M. Hanslianová¹⁰, Z. Turek¹¹, V. Černý^11,12, P. Paterová¹³

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého v Olomouci

² Ústav mikrobiologie, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého v Olomouci

³ Anesteziologicko-resuscitační oddělení, Krajská nemocnice Tomáše Bati

⁴ Ústav lékařské biofyziky, Lékařská fakulta Univerzity Palackého v Olomouci

⁵ Anesteziologicko-resuscitační klinika 1. lékařské fakulty Univerzity Karlovy v Praze a Thomayerovy nemocnice Praha

⁶ Oddělení klinické mikrobiologie, Thomayerova nemocnice Praha

⁷ Katedra intenzivní medicíny, urgentní medicíny a forenzních oborů, Lékařská fakulta Ostravské univerzity v Ostravě

⁸ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Ostrava

⁹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity Brno

¹⁰ Mikrobiologický ústav, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity Brno

¹¹ Centrum pro výzkum a vývoj, Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové

¹² Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada

¹³ Ústav klinické mikrobiologie, Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové

Objective:
This study aimed to obtain recent epidemiological data on hospital-acquired pneumonia (HAP) in intensive care patients and to determine adequate empirical antimicrobial therapy.


Setting:
Department of Anaesthesiology, Resuscitation and Intensive Care Medicine.

Patients and methods:
The prospective, multicenter, observational study assessed the spectrum of detected bacterial pathogens and their resistance to antimicrobial agents. It was compared with a reference approach to initial antibiotic therapy in early- and late-onset HAP.

Results:
Total 317 patients were included in the study. The final patient sample comprised 201 subjects (159 males and 42 females) with a mean age of 59.9 years. Total 260 valid samples of lower respiratory tract secretions were obtained. Early- and late-onset HAP was detected in 26 (12.9%) and 175 (87.1%) patients, respectively. A total of 22 bacterial species were identified as etiological agents, with detection rates higher that 5% being noted in only 6 of them (Klebsiella pneumoniae 20.4%, Pseudomonas aeruginosa 20.0%, Escherichia coli 10.8%, Enterobacter spp. 8.1%, Staphylococcus aureus 6.2% and Burkholderia cepacia complex 5.8%). Gram-negative bacteria were most prevalent (86.1%). Patients with early-onset HAP had considerably higher prevalence of strains of Staphylococcus aureus (26.9%) and Haemophilus influenzae (15.4%). In late-onset HAP, most dominant were the strains of Pseudomonas aeruginosa (21.8%) and Klebsiella pneumoniae (21.4%). Most pathogens causing HAP (74.0%) were shown to have a unique restriction profile. Adequate initial empirical antibiotic therapy was noted in 59.7% of patients.

Conclusion:
The reference approach to initial empirical antibiotic therapy of early- and late-onset HAP was consistent with the spectrum of bacterial pathogens and their susceptibility to antimicrobial agents.

Keywords: nosocomial infections; hospital acquired pneumonia; initial empirical antibiotic therapy; epidemiology; pneumonia

Received: July 20, 2016; Accepted: December 28, 2016; Published: June 1, 2017  Show citation