380. Incidence and Etiology of Early (E) and Late (L) Onset Ventilator-Associated Pneumonia (VAP) in a University Hospital
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Guidelines for therapy of VAP suggest the use of narrow spectrum antibiotics in patients with E-VAP because multi-drug resistant (MDR) bacteria are unlikely in patients with E-VAP. Data on incidence of E-VAP is limited. The objective of this study was to define the incidence and etiology of E-VAP versus L-VAP in a University Hospital.
Methods: A total of 168 consecutive ventilated patients were studied from 11/08 to 2/09. CDC criteria were used to define VAP. E-VAP was defined as development of VAP during the initial 6 days of intubation. VAP incidence was calculated using 1,000 ventilator-days and compared using Z-statistics. Incidence of MDR bacteria was calculated for patients with E-VAP and L-VAP.
Results: E-VAP incidence was 40/1,000 vent-days, and L-VAP incidence was 14/1,000 vent-days (P=0.002). MDR organisms were identified in 46% of E-VAP and 77% of L-VAP.
Conclusion: The risk for the development of VAP is significantly higher during the initial days of mechanical ventilation. E-VAP is commonly produced by MDR organisms. The presence of E-VAP by itself can not be use to select empiric therapy with narrow spectrum antibiotics.
Patricio Cabral, MD1, Martin Gnoni, MD2, Alpa Patel, PharmD3, Paula Peyrani, MD, Julio Ramirez, MD2, James Snyder, PhD5, Timothy Wiemken, MPH2 and  M. Gnoni, None..
P. Cabral, None..
T. Wiemken, None..
P. Peyrani, None..
J. Snyder, None..
A. Patel, None..
J. Ramirez, None., (1)Division of Infectious Diseases, University of Louisville, Louisville, KY, (2)University of Louisville, Louisville, KY, (3)Johns Hopkins Hopital, Baltimore, MD, (4)University of Louisville Hospital