Ventilator-Associated Pneumonia in a Multi-Hospital System Differences in Microbiology by Location

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Abstract
Objective: To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.Design: Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.Setting: Three hospitals—one pediatric teaching hospital, one adult teaching hospital, and one community hospital— in one healthcare system in the midwestern United States.Patients: Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available.Results: Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals wereStaphylococcus aureus(28.4%) andPseudomonas aeruginosa(25.2%). The pediatric hospital had higher proportions ofEscherichia coli(9.5% vs 2.3%;P< .001) andKlebsiella pneumoniae(13% vs 3.1%;P< .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higherP. aeruginosarates than did the neonatal ICU (33.3% vs 17%;P= .01). In the adult hospitals, the surgical ICU had higherAcinetobacter baumanniirates (10.2% vs. 1.7%;P< .001) than did the other ICUs.Conclusions: Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.