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.
机构:
Temple Univ Hosp & Med Sch, Div Cardiol, CTEPH Program, Pulm Hypertens,Right Heart Failure, 9th Floor Parkinson Pavil,3401 North Broad St, Philadelphia, PA 19140 USATemple Univ Hosp & Med Sch, Div Cardiol, CTEPH Program, Pulm Hypertens,Right Heart Failure, 9th Floor Parkinson Pavil,3401 North Broad St, Philadelphia, PA 19140 USA
Vaidy, Anika
O'Corragain, Oisin
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机构:
Temple Univ Hosp & Med Sch, Pulm & Crit Care, Philadelphia, PA USATemple Univ Hosp & Med Sch, Div Cardiol, CTEPH Program, Pulm Hypertens,Right Heart Failure, 9th Floor Parkinson Pavil,3401 North Broad St, Philadelphia, PA 19140 USA
机构:
Guys & St Thomas Hosp NHS Trust, Dept Crit Care Med, London, England
Imperial Coll London, Dept Surg & Canc, London, EnglandGuys & St Thomas Hosp NHS Trust, Dept Crit Care Med, London, England
Cook, David Jonathan
Webb, Stephen
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Royal Papworth Hosp NHS Fdn Trust, Dept Crit Care, Cambridge, EnglandGuys & St Thomas Hosp NHS Trust, Dept Crit Care Med, London, England
Webb, Stephen
Proudfoot, Alastair
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机构:
Barts Hlth NHS Trust, Perioperat Med Dept, London E1 1BB, England
German Heart Ctr Berlin, Dept Anaesthesiol & Intens Care, Berlin, GermanyGuys & St Thomas Hosp NHS Trust, Dept Crit Care Med, London, England