{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T10:11:31Z","timestamp":1781950291677,"version":"3.54.5"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X21004645_as1\"><jats:title>Objective:<\/jats:title><jats:p>To explore whether microbiology profiles and the impact of inappropriate empiric treatment differ in the setting of hospital-acquired bacterial pneumonia that requires subsequent mechanical ventilation (vHABP) versus one that does not (nvHABP) versus ventilator-associated bacterial pneumonia (VABP).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21004645_as2\"><jats:title>Design:<\/jats:title><jats:p>Multicenter retrospective cohort study within Premier Research database, 2014\u20132019.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21004645_as3\"><jats:title>Methods:<\/jats:title><jats:p>We identified cases based on a previously published<jats:italic>International Classification of Disease, Ninth Revision<\/jats:italic>\/<jats:italic>Tenth Revision Clinical Modification<\/jats:italic>(ICD-9\/ICD-10-CM) algorithm, and we compared the 3 groups with respect to the bacterial pathogens isolated from their blood, sputum, or lower airway samples, and their respective rates of exposure to inappropriate empiric treatment. Using regression modeling we computed the effect of inappropriate empiric treatment on outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21004645_as4\"><jats:title>Results:<\/jats:title><jats:p>Among 17,819 patients who met enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP.<jats:italic>S. aureus<\/jats:italic>(majority methicillin-susceptible) was the most frequently isolated organism, followed<jats:italic>P. aeruginosa<\/jats:italic>,<jats:italic>K. pneumoniae<\/jats:italic>, and<jats:italic>E. coli<\/jats:italic>with variations across the conditions. Rates of carbapenem resistance were highest in VABP (9.1%) and to third-generation cephalosporins in vHABP (14.9%). Patients with nvHABP were most likely to receive inappropriate empiric treatment (8.5%). Although inappropriate empiric treatment was associated with an increase in adjusted postinfection-onset hospital length of stay (2.3 days) and cost ($12,142), its greatest magnitude was in the nvHABP group (4.9 days, $13,147).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21004645_as5\"><jats:title>Conclusions:<\/jats:title><jats:p>Substantial microbiologic differences exist among populations who suffer nvHABP, vHABP, and VABP, and inappropriate empiric treatment significantly worsens utilization outcomes. Given the moderate rates of carbapenem resistance and third-generation cephalosporin resistance, all patients require empiric coverage for a range of bacteria, including those targeting extended-spectrum \u03b2-lactamase and carbapenem resistance where appropriate.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2021.464","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T04:03:36Z","timestamp":1648181016000},"page":"277-283","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":22,"title":["Microbiology, empiric therapy and its impact on the outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the United States, 2014\u20132019"],"prefix":"10.1017","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-9761","authenticated-orcid":false,"given":"Marya D.","family":"Zilberberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian H.","family":"Nathanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Puzniak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew F.","family":"Shorr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"S0899823X21004645_ref17","doi-asserted-by":"crossref","first-page":"e87382","DOI":"10.1371\/journal.pone.0087382","article-title":"Using highly detailed administrative data to predict pneumonia mortality","volume":"9","author":"Rothberg","year":"2014","journal-title":"PLoS One"},{"key":"S0899823X21004645_ref11","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1164\/rccm.201001-0094OC","article-title":"Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients","volume":"182","author":"Esperatti","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"S0899823X21004645_ref15","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1017\/ice.2018.166","article-title":"Development and validation of a bedside instrument to predict carbapenem resistance among gram-negative pathogens in complicated urinary tract infections","volume":"39","author":"Zilberberg","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X21004645_ref22","first-page":"PA2636","article-title":"Carbapenem-resistance [sic] pathogens in HAP\/VAP patients in US hospitals between 2010 and 2015","volume":"52","author":"Cai","year":"2018","journal-title":"Eur Resp J"},{"key":"S0899823X21004645_ref7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/cid\/ciq031","article-title":"Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens","volume":"52","author":"Rubinstein","year":"2011","journal-title":"Clin Infect Dis"},{"key":"S0899823X21004645_ref24","unstructured":"24. US Department of Health and Human Services. Data summary of HAIs in the US: assessing progress 2006\u20132016. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/hai\/data\/archive\/data-summary-assessing-progress.html. Published 2017. Accessed March 3, 2022."},{"key":"S0899823X21004645_ref6","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1097\/CCM.0b013e3181691b99","article-title":"Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multicenter, randomized study","volume":"36","author":"Chastre","year":"2008","journal-title":"Crit Care Med"},{"key":"S0899823X21004645_ref19","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1093\/cid\/ciz1049","article-title":"Blood cultures versus respiratory cultures: 2 different views of pneumonia","volume":"71","author":"Haessler","year":"2020","journal-title":"Clin Infect Dis"},{"key":"S0899823X21004645_ref23","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Disease Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin Infect Dis"},{"key":"S0899823X21004645_ref2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.diagmicrobio.2010.05.012","article-title":"Comparison of tigecycline with imipenem\/cilastatin for the treatment of hospital-acquired pneumonia","volume":"68","author":"Freire","year":"2010","journal-title":"Diagn Microbiol Infect Dis"},{"key":"S0899823X21004645_ref25","unstructured":"25. US Department of Health and Human Services. 2016 National and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/hai\/data\/portal\/progress-report.html. Published 2017. Accessed March 3, 2022."},{"key":"S0899823X21004645_ref21","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1186\/1471-2334-13-561","article-title":"A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1,184 patients from a large, international study","volume":"13","author":"Quartin","year":"2013","journal-title":"BMC Infect Dis"},{"key":"S0899823X21004645_ref26","doi-asserted-by":"crossref","first-page":"214","DOI":"10.15585\/mmwr.mm6809e1","article-title":"Vital Signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus Bloodstream infections\u2014United States","volume":"68","author":"Kourtis","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0899823X21004645_ref13","unstructured":"13. Office for Human Research Protections. Human Subject regulations decision charts. US Department of Health and Human Services website. https:\/\/www.hhs.gov\/ohrp\/regulations-and-policy\/decision-charts\/index.html. Accessed February 3, 2021."},{"key":"S0899823X21004645_ref14","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1097\/CCM.0000000000005298","article-title":"Descriptive epidemiology and outcomes of nonventilated hospital-acquired, ventilated hospital-acquired, and ventilator-associated bacterial pneumonia in the US, 2012\u20132019","volume":"50","author":"Zilberberg","year":"2022","journal-title":"Crit Care Med"},{"key":"S0899823X21004645_ref4","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1128\/AAC.01232-12","article-title":"Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia","volume":"57","author":"Ramirez","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"S0899823X21004645_ref9","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0012-3692(15)33412-7","article-title":"Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia","volume":"124","author":"Wunderink","year":"2003","journal-title":"Chest"},{"key":"S0899823X21004645_ref3","doi-asserted-by":"crossref","first-page":"R218","DOI":"10.1186\/cc11862","article-title":"A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin or ventilator-associated pneumonia","volume":"16","author":"Kollef","year":"2012","journal-title":"Crit Care"},{"key":"S0899823X21004645_ref18","doi-asserted-by":"crossref","first-page":"S107","DOI":"10.1086\/677829","article-title":"Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?","volume":"35","author":"Rothberg","year":"2014","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X21004645_ref1","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","article-title":"Multistate point-prevalence survey of healthcare-associated infections","volume":"370","author":"Magill","year":"2014","journal-title":"N Engl J Med"},{"key":"S0899823X21004645_ref16","doi-asserted-by":"crossref","first-page":"ofz504","DOI":"10.1093\/ofid\/ofz504","article-title":"Carbapenem treatment and outcomes among patients with culture-positive complicated intra-abdominal infections in US hospitals: a retrospective cohort study","volume":"6","author":"Zilberberg","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"S0899823X21004645_ref8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1093\/cid\/cir895","article-title":"Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study","volume":"54","author":"Wunderink","year":"2012","journal-title":"Clin Infect Dis"},{"key":"S0899823X21004645_ref10","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.chest.2018.12.024","article-title":"A novel algorithm to analyze epidemiology and outcomes of carbapenem resistance among patients with hospital-acquired and ventilator-associated pneumonia: a retrospective cohort study","volume":"155","author":"Zilberberg","year":"2019","journal-title":"Chest"},{"key":"S0899823X21004645_ref12","doi-asserted-by":"crossref","first-page":"200023","DOI":"10.1183\/16000617.0023-2020","article-title":"Is ventilated hospital-acquired pneumonia a worse entity then ventilator-associated pneumonia?","volume":"29","author":"Vallecoccia","year":"2020","journal-title":"Eur Resp Rev"},{"key":"S0899823X21004645_ref20","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1017\/ice.2016.174","article-title":"Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011\u20132014","volume":"37","author":"Weiner","year":"2016","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X21004645_ref5","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1185\/03007990802179255","article-title":"Efficacy and safety of doripenem versus piperacillin\/tazobactam in nosocomial pneumonia: a randomized, open-label, multicenter study","volume":"24","author":"R\u00e9a-Neto","year":"2008","journal-title":"Curr Med Res Opin"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X21004645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T06:50:28Z","timestamp":1700376628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X21004645\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["S0899823X21004645"],"URL":"https:\/\/doi.org\/10.1017\/ice.2021.464","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3]]},"assertion":[{"value":"\u00a9 Merck & Co., Inc., Kenilworth, NJ, USA and its affiliates and the Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}