In an effort to reduce indiscriminant use of antibiotics, we evaluated the management of VAP at our hospital. A study has shown that using a clinical pulmonary infection score (CPIS) of 6 or less to discontinue antibiotics at day 3 did not affect mortality and decreased resistance, length of ICU stay, and cost. Prior to instituting therapeutic guidelines for VAP using the CPIS, we retrospectively ... [Show full abstract] reviewed the diagnosis and treatment of VAP in our intensive care units (ICU). We determined the number of patients in our hospital that potentially could discontinue antibiotics after 3 days of therapy, based on the CPIS and the potential impact on cost.
Cases were obtained over a six month period from our infection control surveillance, which uses the National Healthcare Safety Network definition for VAP. We evaluated 50 patients, most of whom were in the surgical ICU (74%). At the time of diagnosis, 42/50 patients (84%) had a CPIS less than or equal to 6, of which 23 of 42 (52%) were eligible to have antibiotics stopped at day 3. The average duration of therapy was 13.5 days. Antibiotics costs would be decreased by $9293, if stopped, or approximately $444 per patient. Average length of stay in the ICU for patients who were eligible for short course therapy vs. patients who had VAP, with a CPIS of greater than 6, was 21.8 vs. 18.4 days.
The empiric use of antibiotics is warranted for ICU patients who appear to have VAP. However, as dictated by the clinical course and CPIS, nearly half of our ICU patients could have received 10.5 days less antimicrobial therapy. Length of stay in the ICU appeared to be prolonged for patients who may have received excess antibiotics. We are in the process of instituting guidelines for the management of VAP at our institution using the CPIS to evaluate the impact of a reduction of antimicrobial utilization on patient outcomes of VAP as well as antibiotic resistance.