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Clinical Investigations in Critical CareThe Influence of Mini-BAL Cultures on Patient Outcomes: Implications for the Antibiotic Management of Ventilator-Associated Pneumonia
Section snippets
Study Location and Patients
The study was conducted at a university-affiliated teaching hospital, Barnes-Jewish Hospital (900 beds). During a 12-month period (February 1996 through February 1997), all patients receiving mechanical ventilation within the medical ICU (19 beds) of Barnes-Jewish Hospital were evaluated. All patients with suspected VAP undergoing mini-BAL were entered into the study. Patients were excluded if they were younger than 18 years and if they had massive hemoptysis. The study was approved by the
Patients
A total of 130 consecutive patients requiring mechanical ventilation with suspected VAP were evaluated using mini-BAL (Tables 1 and 2). The mean age of the patients was 52.3±16.8 years (range, 18 to 92 years). Sixty-eight (52.3%) patients were men and 62 (47.7%) were women. The mean APACHE II score of the entire study cohort was 17.3±5.0 (range, 3 to 29). The ICU admitting diagnoses of the study patients included sepsis (n=19), complications of therapy for leukemia, lymphoma, or solid cell
Discussion
We found a statistically significant association between patients receiving inadequate antibiotic therapy (ie, the identification of a pathogen from mini-BAL resistant to the prescribed antibiotic regimen) and subsequent hospital mortality (Fig 2). Multiple logistic regression analysis demonstrated that the risk of hospital mortality was more than three times as great among patients with inadequate antibiotic therapy compared to patients who received adequate antibiotic therapy to treat the
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This research was supported in part by grants from the American Lung Association of Eastern Missouri and Merck and Co Inc.
revision accepted July 15.