A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Pneumonia Caused by Gram-Negative Bacteria in Intensive Care Units: Unit-Specific Combination Antibiograms Versus Patient-Specific Risk Factors
Issued Date
2024-11-01
Resource Type
eISSN
23288957
Scopus ID
2-s2.0-85210293749
Journal Title
Open Forum Infectious Diseases
Volume
11
Issue
11
Rights Holder(s)
SCOPUS
Bibliographic Citation
Open Forum Infectious Diseases Vol.11 No.11 (2024)
Suggested Citation
Wangchinda W., Aitken S.L., Klatt M.E., Lephart P.R., Smith A.B., Pogue J.M. A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Pneumonia Caused by Gram-Negative Bacteria in Intensive Care Units: Unit-Specific Combination Antibiograms Versus Patient-Specific Risk Factors. Open Forum Infectious Diseases Vol.11 No.11 (2024). doi:10.1093/ofid/ofae643 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/102276
Title
A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Pneumonia Caused by Gram-Negative Bacteria in Intensive Care Units: Unit-Specific Combination Antibiograms Versus Patient-Specific Risk Factors
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Guidelines suggest dual antipseudomonal therapy for empiric treatment of pneumonia caused by gram-negative bacteria in intensive care unit (ICU) patients. Additionally, consideration of local susceptibility data and patient-specific risk factors for resistance is recommended for selecting optimal empiric regimens. However, data assessing how to best do this are lacking, and it is unclear whether a local susceptibility data-based or a patient-specific risk factor-based approach will better drive appropriate empiric treatment. This study aims to compare these 2 strategies. Methods: This retrospective study was divided into 2 periods. In period I, gram-negative respiratory cultures from ICU patients were used to develop unit-specific combination antibiograms, and individual patient charts were reviewed to assess the impact of risk factors on antimicrobial susceptibility to develop a risk factor-based treatment algorithm. Optimal empiric regimens based on these 2 strategies were then defined. In period II, these regimens were hypothetically applied to patients to compare rates of appropriate empiric therapy and overuse by the 2 methods. Results: Risk factor-based regimens had a higher appropriateness rate compared to regimens derived from antibiograms (89.9% vs 83.7%). Additionally, applying antibiogram-based regimens resulted in a higher prevalence of antibiotic overuse than a patient-specific risk factor-based approach (69.8% vs 40.3%), with excess overuse driven by a higher frequency of unnecessary use of combination therapy. Conclusions: Both strategies provided high rates of appropriateness in empiric antibiotic selection. However, the patient-specific risk factor-based approach demonstrated a higher rate of appropriate therapy and offered advantages in reducing rates of unnecessary combination therapy.