Antimicrobial Stewardship Program and Ventilator Associated Pneumonia
Condition: Ventilator Associated Pneumonia
MeSH terms: Pneumonia; Pneumonia, Ventilator-Associated
Study type: Observational

Summary: 
      Antibiotic Stewardship Programs (ASPs) help clinicians improve the quality of patient care
      and improve patient safety through increased infection cure rates, reduced treatment
      failures; however, there are different techniques, with variable results, of its application
      including what is called ASPs bundle and there is a need to investigate the effectiveness of
      implementing a comprehensive care bundle program including the key components of ASPs and the
      key items of infection control measures, this program can be called Antimicrobial Stewardship
      Comprehensive Care Bundle Program (ASCCBP).
    

Detailed description: 
      Survey experimental study will be done in the first 6 months as regard antimicrobial drugs
      pattern and organism's sensitivity and resistance pattern in VAP patients.

      In the next six months, clinical implementation of ASPs and infection control bundle will be
      applied on VAP patients. Then, in the later six months the investigators will study the
      outcome of VAP patients as regard:

        -  Amount of cost of antibiotics.

        -  Appropriates of antibiotic use (initiation, duration & time of discontinuation).

        -  Rate of resistance

        -  Clinical outcome, infection rate &length of stay.

      Regular reports on antibiotic use and resistance will be admitted to relevant staff every one
      month. Also, audit and feedback about resistance and optimal prescribing will be applied
      every one month for ICU stuff as an open discussion.

      The stewardship consulting team will include microbiologist with clinical experience in the
      field of antibiotic use and infection control. Stewardship team also will include the
      relevant ICU staff and an experienced clinical pharmacist.
    

Intervention name(s): implementation of antimicrobial stewardship comprehensive care bundle program on ventilator associated pneumonia patients
Intervention type(s): Other
Intervention description(s): Construction of a comprehensive care bundle educational program. This program consisted of many elements: Antimicrobial stewardship programs, VAP bundles and infection control policy implementation and the investigators studied the impact of this program on:
Antibiotics cost.
Appropriates of antibiotic use (initiation, duration & time of discontinuation).
Rate of resistance
Clinical outcome, infection rate &length of stay.
Intervention MeSH terms: Anti-Infective Agents; Anti-Bacterial Agents
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Patients, ≥18 years, who were intubated and mechanically ventilated for more than 48 hours
        in ICU and showing clinical criteria of VAP. Diagnosis was based on the clinical pulmonary
        infection score then it was confirmed microbiologically by culture results. Clinical VAP
        criteria included the presence of a new or progressive pulmonary infiltrates on chest
        radiograph, fever (greater than 38.3°C), leukocytosis or leucopenia and appearance of
        purulent tracheobronchial secretions
      
Biospecimen description: 
      sputum culture and sensitivity