Students Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Endotracheal aspiration (ETA) and bronchoalveolar lavage (BAL) are utilized to diagnose and guide management of ventilator-associated pneumonia (VAP). No robust studies exist analyzing the prevalence of antibiotic overuse/misuse, costs, and safety between these two procedures.
Research Question or Hypothesis: What is the difference between ETA and BAL for diagnosis and management of VAP?
Study Design: Monocentric, retrospective cohort
Methods: Adult patients admitted between July 2012-December 2022 with at least one ETA or BAL culture performed to diagnose VAP were included. The primary outcome was prevalence of antibiotic overuse/misuse in ETA versus BAL populations. Secondary endpoints included treatment costs, intensive care unit (ICU)/hospital length of stay (LOS), and antibiotic-associated adverse events (AAAE). Chi-Square or Fisher’s Exact and Mann-Whitney U tests (SPSS v29.0) were used for categorical and continuous data, respectively. Statistical significance was defined as P<0.05.
Results: 102 patients were included. The population median age was 53 with a median Charlson Score of 2, was minority female, and 21.6% required the use of vasoactive medications. Gram-negative organisms (80%) were isolated more than gram-positive (47%); almost 50% of cultures were polymicrobial. BAL group had post-culture antibiotic modifications more frequently (93% vs 76%; p=0.017). Empiric antibiotics (93%) were vancomycin (75%), cefepime (48%), and fluoroquinolones (37%); definitive antibiotics were cefepime (27%), 3rd-generation cephalosporins (23%), and vancomycin (20%). Antibiotic overuse (50% BAL vs 39% ETA; p=0.272), antibiotic misuse (4% BAL vs 2% ETA; p=1.0), and AAAE (11% BAL vs 20% ETA; p=0.209) were comparable between groups. Cost of hospital stay (USD: $392,299 BAL vs $221,513 ETA; p<0.001), hospital LOS (29 days BAL vs 20 days ETA; p=0.010) and ICU LOS (22 days BAL vs 16 days ETA; p=0.017) were statistically different.
Conclusion: Differences in costs and LOS were significant between groups, possibly due to severity of illness, which was not assessed. Studies controlling for severity of illness may clarify recommendations for BAL vs. ETA.
Presenting Author
Leah K. Franks BSPSUniversity of Mississippi
Authors
Katie E. Barber PharmD
University of Mississippi School of Pharmacy
Jamie L. Wagner PharmD, BCPS, BCIDP
University of Mississippi School of Pharmacy
Kayla R. Stover PharmD, BCIDP, BCPS, FCCP, FIDSA
University of Mississippi School of Pharmacy