Effect of an Educational Intervention on the Management of Ventilator-Associated Pneumonia

Background: The publication of guidelines for the management of ventilator-associated pneumonia prompted an evaluation of management of this condition in the intensive care unit (ICU) of a community acute care hospital. Objectives: To evaluate the management of ventilator-associated pneumonia before and after an educational intervention for physicians and to determine the pathogens responsible for this condition among patients in this ICU. Methods: The management of ventilator-associated pneumonia was reviewed, and compliance with published guidelines and with clinically appropriate therapy (in terms of subsequent culture results or local practice) was evaluated for the 7 months before and the 6 months after the 1-week educational intervention. Results: A total of 42 episodes of ventilator-associated pneumonia, which occurred in 37 patients, were evaluated. After the educational intervention, the following changes in end points were observed: appropriate selection of empiric antibiotic therapy according to guidelines increased from 35% of episodes before to 59% of episodes after the intervention (p = 0.11), whereas the selection of empiric therapy subsequently deemed to be clinically appropriate increased from 45% to 77% (p = 0.032); appropriate dosing according to guidelines increased from 20% to 33% (p = 0.33), whereas clinically appropriate dosing increased from 70% to 95% (p = 0.027); appropriate route of therapy according to the guidelines increased from 75% to 82% (p = 0.59) but there was no change in clinically appropriate route of therapy (100% in both phases); timeliness of therapy increased from 85% to 91% (p = 0.56), de-escalation (narrowing of empiric therapy on the basis of culture results) increased from 60% to 100% (p = 0.11), and appropriate duration of therapy decreased from 79% to 55% (p = 0.11). Conclusions: Clinically appropriate selection and dosing of antibiotics for ventilator-associated pneumonia improved after the educational intervention for physicians. The availability of local microbiological data was valuable in guiding empiric antibiotic selection.