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CRITICAL CARE

Multicenter Treatment and Outcome Evaluation of Aspiration Syndromes in Critically Ill Patients

Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Center for Pharmacoinformatics and Outcomes Research, Pittsburgh, PA

Keith M Olsen, PharmD FCCP FCCM

Professor of Pharmacy, University of Nebraska Medical Center, Omaha, NE

Jill A Rebuck, PharmD BCPS

Clinical Assistant Professor of Surgery, Trauma/Critical Care, Department of Pharmacotherapy, Fletcher Allen Health Care, Burlington, VT

Rhonda S Rea, PharmD

Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh; Critical Care Specialist, University of Pittsburgh Medical Center, Pittsburgh

D Wesston Boatwright, PharmD

Medical Affairs, Roche Laboratories, Inc., Jacksonville, FL

Maureen A Smythe, PharmD FCCP BCPS

Professor, Department of Pharmacy Practice, Wayne State University, Detroit, MI

Terrence R Walker, PharmD

Associate Director, Clinical Affairs, Ortho Biotech, Bridgewater, NJ

Stephanie L Lager, PharmD

Critical Care Specialist, Department of Pharmacy, Heartland Regional Medical Center, St. Joseph, MO

Tudy Hodgman, PharmD BCPS

Critical Care Specialist, Department of Pharmacy, Northwest Community Hospital, Arlington Heights, IL

for the Aspiration Evaluation Group of the Clinical Pharmacy and Pharmacology Section

Reprints: Dr. Kane-Gill, University of Pittsburgh Center for Pharmacoinformatics and Outcomes Research, 918 Salk Hall, 3501 Terrace St., Pittsburgh, PA 15261, fax 412/624-1850, KaneSL{at}upmc.edu

BACKGROUND: Aspiration syndromes (pneumonia and pneumonitis) have significantly different processes. An evaluation of treatment and outcomes for these different syndromes has not been reported previously.

OBJECTIVE: To characterize and assess antimicrobial prescribing patterns for aspiration syndromes in intensive care unit (ICU) patients and describe outcomes of those patients.

METHODS: A retrospective, observational evaluation was conducted using a convenience sample of patients at 27 hospitals in North America; these patients were admitted to an adult ICU with a diagnosis of suspected/confirmed aspiration or had a suspected/confirmed aspiration while in the ICU. Hospital demographic, diagnosis, treatment, and clinical outcome data were collected.

RESULTS: Over a 12 month period, 187 patients were observed. Aspiration syndromes included suspected aspiration (31%; n = 58), aspiration pneumonitis (12%; n = 23), aspiration pneumonia (55%; n = 103), and diagnosis not available (1.6%; n = 3). Antimicrobial management for the aspiration syndromes was as follows: suspected aspiration: 59% single agent, 38% multiple agents, and 3% no therapy; aspiration pneumonitis: 48% single agent, 39% multiple agents, and 13% no therapy; aspiration pneumonia: 48% single agent, 52% multiple agents, and 0% no therapy. Antimicrobial therapy was prescribed in patients with suspected (97%) and confirmed (100%) aspiration. Antibiotic therapy duration was significantly longer for aspiration pneumonia (9.1 ± 7.5 days) than for aspiration pneumonitis (5.2 ± 3.6 days; p = 0.013). Length of ICU stay was similar across patient groups.

CONCLUSIONS: Antimicrobial agents are frequently prescribed to treat aspiration syndromes despite the lack of demonstrated efficacy for aspiration pneumonitis. Outcomes between aspiration syndromes were similar with the exception of duration of antibiotic treatment.

Key Words: aspiration syndromes, intensive care unit, critically ill, pneumonia, pneumonitis

Published Online, March 27, 2007. www.theannals.com, DOI 10.1345/aph.1H675