368. Evaluating Healthcare-Associated Pneumonia (HCAP) in Intensive Care: A Retrospective Analysis of 278 Patients
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-097 HCAP in ICU - IDSA11.pdf (1.1 MB)
  • Background: In the 2005 update of the ATS/IDSA guidelines on nosocomial pneumonia, healthcare-associated pneumonia (HCAP) is included in the spectrum of hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) with the recommendation that such patients need therapy for multidrug-resistant (MDR) bacterial pathogens. There is ongoing debate regarding the present association of HCAP with MDR pathogens, and concern that could lead to overuse of antibiotics. We sought to compare pathogen distribution and clinical outcomes of HCAP vs. HAP/VAP in hospitalized intensive care (ICU) patients with pneumonia.

    Methods: Retrospective, multicenter observational evaluation of ICU patients with pneumonia enrolled in the IMPACT-HAP study (02/06 - 07/07). We used CDC criteria for the diagnosis of pneumonia and ATS/IDSA definitions for HAP, VAP, and HCAP. All patients had a confirmed microbiologic diagnosis (≥1 pathogen identified).

    Results: Data on 278 ICU patients (HCAP=46, HAP=43, and VAP=189) were analyzed. The frequency distribution of bacterial isolates, including MDR pathogens, was similar in the 2 groups of patients [Table 1]. Initial empiric therapy included ≥1 antibiotic active against most pathogen(s) recovered from patients with HCAP, HAP/VAP. Clinical success at day 14 (73% vs. 67%, p=0.43), day 28 (70% vs. 61%, p=0.34), and all-cause mortality day 28 (11% vs. 15.5%, p=0.64) were comparable between the groups.

    Conclusion: Similar bacterial pathogen distribution and comparable outcomes between HCAP and HAP/VAP support the ATS/IDSA Guidelines classification of ICU HCAP in the same spectrum of HAP and VAP. ICU HCAP patients require broad-spectrum therapy for potential MDR pathogens.

    TABLE 1. Group comparison.

     

    HCAP (n=46)

    HAP/VAP (n=232)

    p-value

    MRSA

    21 (45.7%)

    101(43.5%)

    0.79

    P. aeruginosa

    7 (15.2%)

    31 (13.4%)

    0.81

    Acinetobacter spp.

    2 (4.3%)

    15 (6.5%)

    0.75

    Enteric GNB

    8 (17.4%)

    40 (17.2%)

    1.0

    MSSA

    3 (6.5%)

    27 (10.3%)

    0.59

    Respiratory pathogens (S. pneumoniae, H. influenzae)

    3 (6.5%)

    10 (4.3%)

    0.46

    Others

    2 (4.3%)

    11 (4.7%)

    1.0

    Polymicrobial episodes

    13 (28.3%)

    63 (27.2%)

    0.88

    Pathogen 1 covered by empiric antibiotic therapy

    44/45 (97.8%)

    161/179 (89.9%)

    0.09

    Pathogen 2 covered by empiric antibiotic therapy

    12/12 (100%)

    43/56 (76.8%)

    0.06

     


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Thomas M. File Jr., MD MSc1, Paula Peyrani, MD2, Kimbal D. Ford, PharmD3, Verna L. Welch, PhD, MPH4, Ernesto G. Scerpella, MD3 and Julio Ramirez, MD2, (1)Summa Health System, Akron, OH, (2)Division of Infectious Diseases, University of Louisville, Louisville, KY, (3)Infectious Diseases, Specialty Care Medicines Development Group, Pfizer Inc., Collegeville, PA, (4)US Medical Affairs, Pfizer, Inc, New York, NY

    Disclosures:

    T. M. File Jr., Pfizer: Consultant, Research Contractor and Scientific Advisor, Consulting fee and Research support
    Cerexa/Forest: Consultant, Research Contractor and Scientific Advisor, Consulting fee and Research support
    Astellas: Scientific Advisor, Consulting fee
    Bayer: Consultant, Consulting fee
    CEMPRA: Research Contractor, Research support
    Merck: Scientific Advisor, Consulting fee
    Nabriva: Scientific Advisor, Consulting fee
    Tetraphase: Scientific Advisor, Consulting fee

    P. Peyrani, None

    K. D. Ford, Pfizer, Inc.: Employee and Shareholder, Salary

    V. L. Welch, Pfizer, Inc.: Employee and Shareholder, Salary and Stock

    E. G. Scerpella, Pfizer Inc.: Employee and Shareholder, Salary

    J. Ramirez, Pfizer: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Cubist: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium
    Ortho McNeil: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Educational grant, Grant recipient and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.