392. Management of Health Care Associated Pneumonia (HCAP): Economic Assessment of Compliance to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) Guidelines
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: We developed an ICU HCAP performance improvement project using the 2005 ATS/IDSA guidelines at four academic medical centers. Guideline impact on economic parameters such as duration of mechanical ventilation (MV) support and length of stay (LOS) in the intensive care unit and hospital after diagnosis of HCAP was assessed.
Methods: Data were collected prospectively. Patients (pts) at risk for multidrug resistant organisms (MDRO) were evaluated for severity of illness, adherence to ATS/IDSA guidelines during empiric treatment, and duration of MV and LOS.
Results: 301 pts with MDRO risk received empiric therapy. Therapy was compliant with guidelines in 132 pts (Group 1); noncompliant in 169 pts (Group 2). Reasons for noncompliance included failure to utilize dual therapy for gram negatives in 155 pts and no MRSA coverage in 23 pts. Patients were followed until death, hospital discharge or day 28. At baseline the groups were similar. Distributions of LOS and duration of MV support after diagnosis of HCAP are skewed, so results are presented as median (interquartile bounds). As guideline compliance was associated with increased mortality (30/132 pts Group 1 vs. 19/169 pts Group 2, P<0.01)1, we looked at both the entire study population and 14 day survivors. There were no significant differences in either LOS or MV utilization between groups.
Conclusion: Adherence to the ATS/IDSA guidelines was not associated with a decrease in the duration of MV support or LOS in the either ICU or the hospital after the diagnosis of HCAP.
1. Kett DH et al. The 48th Annual ICAAC/IDSA 46th Annual Meeting. 2008. Abstract 1045, Presentation K-479.
Economic Evaluation
Post HCAP DaysIDSA CompliantIDSA Noncompliant
MV support (TP)8 (3,14)8 (2,16)
LOS ICU (TP)11 (6,22)12 (5,20)
LOS Hosp. (TP)16 (9,28)17 (9,27)
MV Support (D14surv)8 (2,18)8 (2,18)
LOS ICU (D14surv)14 (7,24)13 (6,22)
LOS Hosp. (D14surv)19 (11,32)18 (10,28)
and the IMPACT-HAP Study Group, Ennie Cano, PharmD2, Andrea Castelblanco, MD3, Kimbal Ford, PharmD4, Daniel H. Kett, MD, Julie Mangino, MD5, Paula Peyrani, MD, Andrew Quartin, MD, MPH2, Julio A. Ramirez, MD, Ernesto Scerpella, MD6, Marcus Zervos, MD7 and  D. H. Kett,
Pfizer Role(s): Consultant, Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium, Consulting Fee.
Astellas Role(s): Consultant, Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium, Consulting Fee.
Merck Role(s): Consultant, Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
Cubist Role(s): Consultant, Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
E. Cano, None..
A. A. Quartin, None..
A. S. Castelblanco, None. 
J. A. Ramirez,
Pfizer Role(s): Consultant, Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium, Consulting Fee.
J. E. Mangino,
Pfizer Role(s): Research Relationship, Received: Research Support.
M. J. Zervos,
Pfizer Role(s): Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium.
Cubist Role(s): Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium.
Astellas Role(s): Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium.
P. Peyrani,
Pfizer Role(s): Research Relationship, Received: Research Support.
K. D. Ford,
Pfizer Role(s): Employee, Received: Salary.
E. G. Scerpella,
Pfizer Role(s): Employee, Received: Salary., (1)Univ. of Miami/Jackson Memorial Hospital, (2)Univ. of Miami/Jackson Memorial Hospital/VAMC, (3)Pfizer Inc, Georgetown, KY, (4)Ohio State Univ, Columbus, OH, (5)Pfizer Inc, Miami, FL, (6)Infectious Disease, Henry Ford Hospital, Detroit, MI