Identifying Risk Factors for Gram-negative Resistance for HAP/VAP in the Intensive Care Unit

Study Overview
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Brief Summary
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Single center, retrospective chart review. Patients admitted to MDMC ICU from 4/1/2017 to 6/30/2020 will be identified through the electronic medical record utilizing ICD codes for HAP and VAP.

Detailed Description
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Single center, retrospective chart review. Patients admitted to MDMC ICU from 4/1/2017 to 6/30/2020 will be identified through the electronic medical record utilizing ICD codes for HAP and VAP. Patients with respiratory culture data signifying a Gram-negative organism as the cause of HAP/VAP will be analyzed as described below if study inclusion criteria is met. Minimum inhibitory concentration (MIC) data will interpreted per Clinical & Laboratory Standards Institute (CLSI) standards to determine local patterns of resistance. Multivariable logistic regression will be performed to determine risk factors for piperacillin-tazobactam, cefepime or meropenem resistant Gram-negative isolates. Project target date of completion and close-out is May 2021.

Official Title
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Identifying Risk Factors for Gram-negative Resistance for HAP/VAP in the Intensive Care Unit

Conditions
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Ventilator-associated Pneumonia, Hospital-acquired Pneumonia

Intervention / Treatment
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* Other: Observational


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ICU, Neuro critical care unit admission Diagnosis of HAP or VAP Respiratory culture positive for Gram-negative organism Exclusion Criteria: ICU length of stay <48 hours prior to HAP/VAP Culture or MIC data unavailable Pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Retrospective Cohort<br>Patients admitted to MDMC ICU from 4/1/2017 to 6/30/2020 will be identified through the electronic medical record utilizing ICD codes for HAP and VAP. | Other: Observational<br>* Single center, retrospective chart review. Patients admitted to MDMC ICU from 4/1/2017 to 6/30/2020 will be identified through the electronic medical record utilizing ICD codes for HAP and VAP<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Gram-negative isolate resistance to piperacillin-tazobactam, cefepime, meropenem | Percentage | April 2017 - May 2020 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of susceptibility to non-beta lactam antipseudomonal agents | Percentage | April 2017 - May 2020 | 
| in-hospital mortality | Percentage | April 2017 - May 2020 | 
| need for mechanical ventilation | Percentage | April 2017 - May 2020 | 
| duration of mechanical ventilation | number of days | April 2017 - May 2020 | 
| development of septic shock | Percentage | April 2017 - May 2020 | 
| ICU length of stay | number of days | April 2017 - May 2020 | 
| hospital length of stay | number of days | April 2017 - May 2020 |