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Clinical Investigations in Critical CareClinical Importance of Delays in the Initiation of Appropriate Antibiotic Treatment for Ventilator-Associated Pneumonia
Section snippets
Study Location and Patients
This study was conducted at a university-affiliated urban teaching hospital, Barnes-Jewish Hospital (1,000 beds). During a 1-year period (February 2000 through February 2001), all patients receiving mechanical ventilation in the medical ICU were eligible for this investigation. Patients were excluded from participation if they were transferred to the medical ICU from another hospital while receiving mechanical ventilation or were admitted to the medical ICU temporarily due to unavailability of
Patients
A total of 107 consecutive patients receiving mechanical ventilation and antibiotic treatment for VAP were evaluated. The mean age of the patients was 56.6 ± 16.8 years (range, 17 to 89 years), and the mean APACHE II score of the study cohort was 24.6 ± 8.1 (range, 8 to 47). Sixty-four patients (59.8%) were women, and 43 patients (40.2%) were men. The indications for mechanical ventilation included exacerbations of COPD (n = 15), congestive heart failure (n = 6), community-acquired pneumonia (n
Discussion
We found a statistically significant association between the administration of IDAAT and hospital mortality for patients with VAP. Multiple logistic regression analysis identified IDAAT, increasing severity of illness as measured by APACHE II scores, and the presence of underlying malignancy as important determinants of hospital mortality for this patient cohort. The most common reason identified for the administration of IDAAT was a delay in writing the orders for antibiotic treatment after
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This work was supported in part by the Barnes-Jewish Hospital Foundation.