Experience with a clinical guideline for the treatment of ventilator-associated pneumonia

Objective: To evaluate a clinical guideline for the treatment of ventilator -associated pneumonia. Design: Prospective before-and-after study design. Setting: A medical intensive care unit from a university-affiliated, urban teaching hospital. Patients: Between April 1999 and January 2000, 102 patients were prospectiv ely evaluated. Interventions: Prospective patient surveillance, data collection, and imple mentation of an antimicrobial guideline for the treatment of ventilator-ass ociated pneumonia. Measurements and Main Results: The main outcome evaluated was the initial a dministration of adequate antimicrobial treatment as determined by respirat ory tract cultures. Secondary outcomes evaluated included the duration of a ntimicrobial treatment for ventilator-associated pneumonia, hospital mortal ity, intensive care unit and hospital lengths of stay, and the occurrence o f a second episode of ventilator-associated pneumonia. Fifty consecutive pa tients with ventilator-associated pneumonia were evaluated in the before pe riod and 52 consecutive patients with ventilator-associated pneumonia were evaluated in the after period. Severity of illness using Acute Physiology a nd Chronic Health Evaluation II (25.8 +/- 5.7 vs. 25.4 +/- 8.1, p = .798) a nd the clinical pulmonary infection scores (6.6 +/- 1.0 vs. 6.9 +/- 1.2, p = .105) were similar for patients during the two treatment periods. The ini tial administration of adequate antimicrobial treatment was statistically g reater during the after period compared with the before period (94.2% vs. 4 8.0%, p < .001). The duration of antimicrobial treatment was statistically shorter during the after period compared with the before period (8.6 +/- 5. 1 days vs. 14.8 +/- 8.1 days, p < .001). A second episode of ventilator-ass ociated pneumonia occurred statistically less often among patients in the a fter period (7.7% vs. 24.0%, p = .030). Conclusions: The application of a clinical guideline for the treatment of v entilator-associated pneumonia can increase the initial administration of a dequate antimicrobial treatment and decrease the overall duration of antibi otic treatment. These findings suggest that similar types of guidelines emp loying local microbiological data can be used to improve overall antibiotic utilization for the treatment of ventilator-associated pneumonia.