Management of Hospital-Acquired Pneumonia at a Tertiary-Care Teaching Hospital

Background: The rising resistance of pathogens commonly implicated in hospital-acquired pneumonia to currently recommended empiric therapy may necessitate a change in the management of this condition. Objective: To determine the current therapeutic approach to the management of hospital-acquired pneumonia at an urban tertiary care hospital and to determine the need for a change to the institution's guidelines, according to patterns of bacterial culture and sensitivity. Methods: A chart review was performed to identify patients in whom hospital-acquired pneumonia was diagnosed between January 1 and December 31, 2003. Results: The charts of 50 patients (15% of the 325 patients with a diagnosis of hospital-aquired pneumonia) were reviewed. Most patients (43 or 86%) had stayed on a ward, and the overall mean age was 77 years. The initial choice of antimicrobial regimen was selected empirically for 41 (82%) of the patients; levofloxacin 500 mg daily was the most commonly chosen single agent (15/41 or 37%). Ceftriaxone was also chosen frequently (10/41 or 24%) for the empiric management of hospital-acquired pneumonia. For patients whose therapy was culture-directed, the most commonly chosen agent was ciprofloxacin (5/9 or 56%). Sputum samples were obtained from 19 of the patients, and 3 species of bacteria were each cultured in more than 15% of these 19 samples: methicillin-sensitive Staphylococcus aureus (MSSA) (3/19 or 16%), Hemophilus influenzae (4/19 or 21%), and Serratia marcescens (3/19 or 16%). Conclusions: MSSA, Hemophilus influenzae, and Serratia marcescens were the most common causes of hospital-acquired pneumonia at this institution, but multidrug-resistant strains of these problematic organisms were not a concern. Therefore, broad-spectrum antibiotics, such as carbapenems, ceftazidime, and ciprofloxacin may be reserved for targeted use in appropriate patients. These agents should not be used in the routine empiric management of hospital-acquired pneumonia in the authors' institution at this time.