TY - JOUR
T1 - PROPHETIC EU
T2 - Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts
AU - Bergin, Stephen P
AU - Calvert, Sara B
AU - Farley, John
AU - Sun, Jie-Lena
AU - Chiswell, Karen
AU - Dieperink, Willem
AU - Kluytmans, Jan
AU - Lopez-Delgado, Juan Carlos
AU - Leon-Lopez, Rafael
AU - Zervos, Marcus J
AU - Kollef, Marin H
AU - Sims, Matthew
AU - Kabchi, Badih A
AU - Rubin, Daniel
AU - Santiago, Jonas
AU - Natarajan, Mukil
AU - Tenaerts, Pamela
AU - Fowler, Vance G
AU - Holland, Thomas L
AU - Bonten, Marc J
AU - Hullegie, Sebastiaan J
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2022/7
Y1 - 2022/7
N2 - Background: The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population.Methods: Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of 7 European hospitals were prospectively enrolled from June 12 to December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to US Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in a European cohort and a previously described US cohort.Results: Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia, and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] vs 537/1464 [37%];
P < .001). Among patients developing pneumonia, a higher proportion of European patients met antibacterial trial eligibility criteria (124/150 [83%] vs 371/537 [69%];
P < .001).
Conclusions: Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than US patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States.
AB - Background: The prospective identification of patients at high risk for hospital-acquired/ventilator-associated bacterial pneumonia may improve clinical trial feasibility and foster antibacterial development. In a prior study conducted in the United States, clinical criteria were used to prospectively identify these patients; however, these criteria have not been applied in a European population.Methods: Adults considered high risk for pneumonia (treatment with ventilation or high levels of supplemental oxygen) in the intensive care units of 7 European hospitals were prospectively enrolled from June 12 to December 27, 2017. We estimated the proportion of high-risk patients developing pneumonia according to US Food and Drug Administration guidance and a subset potentially eligible for antibacterial trial enrollment. We compared patient characteristics, treatment exposures, and pneumonia incidence in a European cohort and a previously described US cohort.Results: Of 888 high-risk patients, 211/888 (24%) were treated for possible pneumonia, and 150/888 (17%) met the Food and Drug Administration definition for hospital-acquired/ventilator-associated bacterial pneumonia. A higher proportion of European patients treated for possible pneumonia met the pneumonia definition (150/211 [71%] vs 537/1464 [37%];
P < .001). Among patients developing pneumonia, a higher proportion of European patients met antibacterial trial eligibility criteria (124/150 [83%] vs 371/537 [69%];
P < .001).
Conclusions: Clinical criteria prospectively identified high-risk patients with high rates of pneumonia in the European cohort. Despite higher rates of established risk factors and incident pneumonia, European patients were significantly less likely to receive antibiotics for possible pneumonia than US patients. Different treatment practices may contribute to lower rates of antibacterial trial enrollment in the United States.
KW - Antibacterial agent
KW - Bacterial pneumonia
KW - Health care-associated pneumonia
KW - Intensive care unit
KW - Mechanical ventilator
UR - http://www.scopus.com/inward/record.url?scp=85135711602&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofac231
DO - 10.1093/ofid/ofac231
M3 - Article
C2 - 35836748
SN - 2328-8957
VL - 9
SP - 1
EP - 10
JO - Open forum infectious diseases
JF - Open forum infectious diseases
IS - 7
M1 - ofac231
ER -