Improvement in Diagnosis and Management of Nosocomial Pneumonias in a Cardiovascular Surgery Intensive Care Unit: A Multidisciplinary Approach

被引:0
|
作者
Kooda, Kirstin J. [1 ]
Zambrano, Alejandra A. [2 ]
Kosaski, Dylan L. [1 ]
Higbe, Leah [2 ]
Beam, William Brian B. [3 ]
Bohman, J. Kyle K. [3 ]
Wittwer, Erica D. [3 ]
Brady, Steven D. [4 ]
LeMahieu, Allison M. [5 ]
Fida, Madiha [6 ]
Shah, Aditya [6 ]
机构
[1] Mayo Clin, Dept Pharm Serv, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Infect Prevent & Control, Rochester, MN 55902 USA
[3] Mayo Clin, Dept Anesthesiol, Rochester, MN 55902 USA
[4] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55902 USA
[5] Mayo Clin, Dept Quantitat Hlth Sci, Rochester, MN 55902 USA
[6] Mayo Clin, Div Publ Hlth Infect Dis & Occupat Med, Rochester, MN 55902 USA
来源
ANTIBIOTICS-BASEL | 2024年 / 13卷 / 07期
关键词
nosocomial pneumonia; informatics; visual analytics; antimicrobial stewardship; diagnostic stewardship; infection prevention and control; VENTILATOR-ASSOCIATED PNEUMONIA; CARDIAC-SURGERY; GUIDELINES;
D O I
10.3390/antibiotics13070590
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: While criteria for the diagnosis of nosocomial pneumonias exist, objective definitions are a challenge and there is no gold standard for diagnosis. We analyzed the impact of the implementation of a logical, consensus-based diagnostic and treatment protocol for managing nosocomial pneumonias in the cardiovascular surgery intensive care unit (CVS-ICU). Methods: We conducted a quasi-experimental, interrupted time series analysis to evaluate the impact of a diagnostic and treatment protocol for nosocomial pneumonias in the CVS-ICU. Impacts were measured relative to patient outcomes, diagnostic processes, and antimicrobial stewardship improvement. Descriptive statistics were used to analyze results. Results: Overall, 35 pre-protocol and 39 post-protocol patients were included. Primary clinical variables suggesting pneumonia in pre- and post-protocol patients were new lung consolidation (50% vs. 71%), new leukocytosis (59% vs. 64%), and positive culture (32% vs. 55%). Appropriate diagnostic testing improved (23% vs. 54%, p = 0.008) after protocol implementation. The proportion of patients meeting the criteria for nosocomial pneumonia (77% vs. 87%) was not statistically significant, though more patients in the post-protocol group met probable diagnostic criteria (51% vs. 77%). Duration of therapy was not significantly different (6 days [IQR = 5.0, 10.0] vs. 7 days [IQR = 6.0, 9.0]). Conclusions: The implementation of a diagnostic and treatment protocol for management of nosocomial pneumonias in the CVS-ICU resulted in improved diagnostic accuracy, advanced antimicrobial and diagnostic stewardship efforts, and laboratory cost savings without an adverse impact on patient-centered outcomes.
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页数:12
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