Tuberc Respir Dis.  2020 Jan;83(1):81-88. 10.4046/trd.2019.0012.

The Use of Inappropriate Antibiotics in Patients Admitted to Intensive Care Units with Nursing Home–Acquired Pneumonia at a Korean Teaching Hospital

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. inspirit26@gmail.com
  • 2Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
  • 3Department of Neurosurgery, Neuroscience, Radiosurgery and Adaptive Hybrid Neurosurgery Research Center, Inje University Ilsan Paik Hospital, Goyang, Korea.

Abstract

BACKGROUND
Use of appropriate antibiotics for the treatment of pneumonia is integral in patients admitted to intensive care units (ICUs). Although it is recommended that empirical treatment regimens should be based on the local distribution of pathogens in patients with suspected hospital-acquired pneumonia, few studies observe patients admitted to ICUs with nursing home-acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER).
METHODS
We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015-May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression.
RESULTS
Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics-treated group than in the appropriate antibiotics-treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER.
CONCLUSION
NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.

Keyword

Nursing Home–Acquired Pneumonia; Pneumonia; Intensive Care Unit

MeSH Terms

Anti-Bacterial Agents*
Bacteria
Cohort Studies
Critical Care*
Emergency Service, Hospital
Hospitals, Teaching*
Humans
Intensive Care Units*
Logistic Models
Methicillin-Resistant Staphylococcus aureus
Multivariate Analysis
Nursing*
Pneumonia*
Retrospective Studies
Risk Factors
Anti-Bacterial Agents
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