1242. The Impact of an Infection Control Bundle on Ventilator Associated Pneumonia Pathogens in the Intensive Care Units
Session: Poster Abstract Session: Sepsis and Critical Care
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

National ventilator associated pneumonia (VAP) guidelines recommend VAP prevention bundles and empiric treatment based on local microbiology.  However, the impact of infection control measures on local microbiology and VAP treatment has not been well described.

Methods: 

Retrospective study at a university affiliated teaching hospital, and level 1 trauma and burn center.  Diagnostic and treatment guidelines for VAP was implemented in July 2004 based on local microbiology.  All patients admitted to the intensive care unit on mechanical ventilation ≥ 48 hours who met diagnostic criteria for VAP by quantitative lower respiratory tract cultures obtained via bronchoscopic alveolar lavage (BAL) between July 2008 and June 2010 were included.  Early and late onset VAP was defined as mechanical ventialtion or hospitalization ≤ 4 days and > 5 days, respectively.  Microbiology data for VAP during the study period was compared to historical control data (July 2003 to June 2004).  Infection control measures were implemented in stages including hand hygiene, active surveillance cultures for carbapenem-resistant Acinetobacter and methicillin-resistant Staphylococcus aureus (MRSA), use of contact precautions, VAP preventive bundle, and daily chlorhexidine baths starting in January 2005.

Results: 

Two hundred sixty nine patients with BAL-confirmed VAP were included, of whom 72 (27%) and 197 (73%) were categorized as early and late onset VAP, respectively.  Compared to historical control, the predominant organisms responsible for early onset VAP remained as MSSA (27% vs. 29%), Haemophilus spp. (27% vs. 22%) and S. pneumoniae (20% vs. 18%) during the study period (p=NS).  In late onset VAP, the prevalence of MRSA and Acinetobacter responsible for VAP decreased from 23% to 5% (p<0.0001), and 32% to 4% (p<0.0001), respectively, however, the prevalence of MSSA increased from 15% to 27% (p = 0.01) during the study period. Given these changes, a new guideline for empiric VAP antibiotic was implemented.

Conclusion: 

Infection control measures have significant impact on microbiology patterns of VAP.  It is important to re-evaluate treatment algorithms based on local microbiology susceptibility patterns.


Subject Category: J. Clinical practice issues

Jeannie D. Chan, PharmD, MPH1, Timothy H. Dellit, MD2, Elizabeth McNamara, RN, MN3 and John B. Lynch, MD2, (1)Pharmacy, Harborview Medical Center, Seattle, WA, (2)Medicine, Division of Infectious Diseases, Harborview Medical Center, Seattle, WA, (3)Harborview Medical Center, Seattle, WA

Disclosures:

J. D. Chan, None

T. H. Dellit, None

E. McNamara, None

J. B. Lynch, None

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