Impact of Empiric Monotherapy versus Combination Therapy for Treatment of Gram Negative Hospital Acquired Pneumonia Anna Bush, PharmD; Jason Lin, PharmD; Audrey Johnson, PharmD, BCPS Memorial University Medical Center - Savannah, GA
Background/Purpose: The Infectious Diseases Society of America and the American Thoracic Society recently collaborated to publish a set of evidence based, clinical practice guidelines for the treatment of hospital acquired pneumonia. These guidelines suggest adding empiric gram negative double coverage in patients with risk of multidrug resistance organisms, structural lung disease or high mortality risk. However, there is limited evidence addressing single versus double empiric antibiotic coverage. The aim of this study is to evaluate if empiric monotherapy gram negative coverage achieves equal outcomes compared to double gram negative coverage in patients with gram negative hospital acquired pneumonia.
Methodology: This IRB approved, retrospective chart review included patients eighteen years of age or older admitted to Memorial Health University Medical Center who subsequently developed hospital acquired pneumonia. The primary outcome measure is clinical cure rate of monotherapy versus combination therapy for empiric gram negative coverage. White blood cell count and fever curve were used to determine clinical treatment success. Secondary outcomes include adequacy of initial treatment, incidence of resistant organisms and in hospital mortality. Both the incidence of clostridium difficile infection and acute kidney injury were included as safety outcomes. Collected data includes concomitant comorbidities, use of previous antimicrobial therapy in last ninety days and duration of antimicrobial therapy.
Presentation Objective: Evaluate the risks and benefits of empiric combination therapy versus monotherapy in patients with gram negative hospital acquired pneumonia.
Self-Assessment: When is it appropriate to recommend empiric gram negative combination therapy in patients with hospital acquired pneumonia?
