Incidence and outcomes of pneumonia in intubated patients in a mixed ICU setting

Author(s):
Alyssa Douville; Emily Johnson; Lesley Paige Clement; Savannah Gross; Kailee Severt; Srishti Singal; Christopher Merrick; Nathan Schmoekel; Brett Fair; Thomas Schroeppel

Background:

Pneumonia is a leading cause of morbidity and mortality in ICU patients. Organisms associated with pneumonia vary according to duration of mechanical ventilation (MV), length of stay (LOS), antimicrobial exposure, and local ecology. Objectives of this study are to define incidence, organisms, and outcomes of pneumonia in intubated patients in a mixed ICU setting. Surgical/trauma (SICU) and medical ICU (MICU) teams treat unique patient populations.

Hypothesis:

We hypothesize that patient demographics are more predictive of causative organism rather than physical care environment.

Methods:

A retrospective comparison of SICU and MICU patients who received bronchial alveolar lavage/wash between January and December 2022 was performed at a level-1 trauma center. Patients were categorized by service performing bronchoscopy. Variables collected include demographics, hospital and ICU LOS, mortality, MV duration prior to bronchoscopy, duration of MV, pathogens, sensitivities, antimicrobial regimens and duration of therapy.  Categorical variables were analyzed with Chi square or Fisher’s exact test and continuous variables were analyzed with Student’s t-test or Wilcoxon rank sum based on data distribution.

Results:

121 patients were identified. Normal flora was most commonly identified in both patient populations. Demographics and outcome data are listed in table 1.

Conclusions:

Within a mixed ICU setting, the patient population and primary care team contributed to rates and timing of bronchoscopy in intubated patients. Unit-specific antibiograms are useful for geographic location, but fail to differentiate between unique patient populations. Differences in treatment timing and outcomes specific to intubated MICU and SICU patients with pneumonia were identified.  Selection of empiric antibiotics should be driven by the characteristics of each patient population, rather than the physical location of care provided.