Pharmacodynamic-based clinical pathway for empiric antibiotic choice in patients with ventilator-associated pneumonia

被引:65
作者
Nicasio, Anthony M. [1 ]
Eagye, Kathryn J. [1 ]
Nicolau, David P. [1 ,2 ]
Shore, Eric [3 ,6 ]
Palter, Marc [4 ]
Pepe, Judith [5 ,6 ]
Kuti, Joseph L. [1 ]
机构
[1] Hartford Hosp, Ctr Antiinfect Res & Dev, Hartford, CT 06102 USA
[2] Hartford Hosp, Div Infect Dis, Hartford, CT 06102 USA
[3] Hartford Hosp, Div Pulm Crit Care, Hartford, CT 06102 USA
[4] Hartford Hosp, Div Neurosurg Crit Care, Hartford, CT 06102 USA
[5] Hartford Hosp, Div Surg Crit Care, Hartford, CT 06102 USA
[6] Univ Connecticut, Sch Med, Farmington, CT 06030 USA
关键词
Ventilator-associated pneumonia; Antibiotics; Pharmacodynamics; ICU; Resistance; Mortality; INTERMITTENT INFUSION; DOSING STRATEGY; THERAPY; APPROPRIATENESS; MULTICENTER; INFECTIONS; GUIDELINES; EXPERIENCE; MANAGEMENT; MEROPENEM;
D O I
10.1016/j.jcrc.2009.02.014
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Because 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 (M IC) distributions and pharmacodynamic modeling in 3 of our ICUs. Methods: This 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. Results: Pharmacodynamic 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.
引用
收藏
页码:69 / 77
页数:9
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