378. Outcome of Intensive Care Unit (ICU) patients with Hospital-Acquired Pneumonia (HAP) is not related to causative organism: Results from the IMPACT HAP Study
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Hospital-Acquired Pneumonia (HAP) in ICU patients is caused by a wide spectrum of bacterial organisms. Guidelines recognize that many patients with HAP are infected with multidrug-resistant (MDR) bacteria that threaten the adequacy of initial, empirical antibiotic therapy. The objective of this study was to describe the characteristics and outcomes of HAP caused by pathogen groups in patients treated in line with current guidelines.
Methods: We developed an ICU HAP performance improvement project at 4 institutions based on the 2005 ATS/IDSA guidelines (IMPACT HAP study). Data on patients with HAP and a documented bacterial etiology were prospectively collected. Cases were divided in 3 groups based on the etiology of HAP: Gram-positive (GP), Gram-negative (GN), and mixed infection (GP+GN).
Results: A total of 279 HAP patients were included: 134 GP, 102 GN, and 43 GP+GN. There were no significant differences between groups with respect to age, gender, APACHE II score.
GP patients had higher mean Clinical Pulmonary Infection Score (CPIS) at diagnosis (P=0.02), and more GP patients had an initial CPIS >6 (P=0.03).
GN patients had the longest (13.2 days) and GP the shortest (8.75 days) intervals from admission to diagnosis of HAP (P=0.04).
A majority of patients received active empirical antibiotic therapy:
GPGNGP+GN
Pathogen 1 covered88/95 (92.6%)84/94 (89.4%)34/36 (94.4%)
Pathogen 2 covered--31/36 (86.1%)
Risk factors for MDR92.5%98%*86%

*P=0.023
There were no outcome differences between the groups with respect to hospital and ICU length of stay, ventilator days, and Day 28 mortality.
Conclusions: GP HAP presents with a higher CPIS and shorter interval from admission to diagnosis. No outcome or survival disadvantage observed among the 3 groups despite a high frequency of risk factors for MDR. Patients who receive adequate initial empirical therapy have similar outcomes regardless of infecting pathogen(s).
Kimbal Ford, PharmD, Pfizer Inc, Georgetown, KY, Nadia Haque, Pharm, D, Infectious Disease, Henry Ford Hospital, Detroit, MI, Daniel Kett, MD, Univ of Miami/Jackson Mem Hosp, Miami, FL, Julie Mangino, MD, Ohio State Univ, Columbus, OH, Paula Peyrani, MD, Julio A. Ramirez, MD, Ernesto Scerpella, MD, Pfizer Inc, Miami, FL, The IMPACT HAP Study Group, Verna Welch, PhD, MPH, Pfizer Inc, Snellville, GA, Marc Zervos, MD, Henry Ford Health System and  E. G. Scerpella,
Pfizer Inc Role(s): Employee, Received: Salary.
V. L. Welch,
Pfizer Inc Role(s): Employee, Received: Salary.
P. Peyrani,
Pfizer Inc Role(s): Research Relationship, Received: Research Support.
N. Z. Haque, None. 
K. D. Ford,
Pfizer Inc Role(s): Employee, Received: Salary.
J. E. Mangino,
Pfizer Inc Role(s): Research Relationship, Received: Research Support.
D. H. Kett,
Pfizer Inc 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.
M. J. Zervos,
Pfizer Inc Role(s): Consultant, Grant Investigator, Research Relationship, Speaker's Bureau, Received: Research Grant, Speaker Honorarium.
Cubist Role(s): Consultant, Grant Investigator, Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium.
Astellas Role(s): Consultant, Grant Investigator, Research Relationship, Received: Research Support, Speaker Honorarium.
J. A. Ramirez,
Pfizer Inc Role(s): Investigator, Research Relationship, Speaker's Bureau, Received: Research Support, Speaker Honorarium.