Microbiological diagnostic and antibiotic management of community aquired and nosocomial pneumonias in intensive care units in Germany]

Objective: To evaluate microbiological diagnostic and empiric antibiotic therapy of community acquired or nosocomial pneumonia in intensive care units (ICU) in Germany. Methods: A surveillance system on antibiotic use and bacterial resistance was started in Germany in February 2000 (SARI - Surveillance on antibiotic use and bacterial resistance in ICUs). In March 2003 a questionnaire on routine microbiological diagnostic and empiric antibiotic treatment of community acquired, ventilator associated early onset, ventilator associated late onset or community acquired aspiration pneumonia was sent to all participating ICUs (n = 38) Results: A response rate of 76 % was obtained. 20 of 29 ICUs stated that they follow written guidelines on antibiotic treatment. 17 % of the ICUs do not perform routine microbiological diagnostics of community acquired pneumonia, and 7 % (n = 2) do not do so in the case of nosocomial pneumonia. 52 % of ICUs practice an invasive procedure by brocheoalvolar lavage, when nosocomial pneumonia is suspected. 11 ICUs treat community-acquired pneumonia empirically with a 2nd generation cephalosporin, 14 lCUs prefer a combination therapy with macrolides. 29 lCUs use at least seven different regimes for empiric treatment of ventilator-associated early onset, ventilator-associated late onset or community-acquired aspiration pneumonia Over half of the ICUs (52 %) use piperacillin with lactamase inhibitor as first line treatment in the case of ventilator-associated late onset pneumonia. Nine out of 29 ICUs prefer a combination therapy, five ICUs a monotherapy with 3rd generation cephalosporins or quinolones although resistance rates for pseudomonas aeruginosa in German ICUs is 15.9 % for ceftazidime, 26.1 % for imipenem, 24.3 % for piperacillin/tazobactam and 18.3 % for ciprofloxacin. Conclusion: There are wide variations in microbiological diagnostic and empiric antibiotic treatment of pneumonia in German ICUs. In some cases,study results and recommendations/guidelines are not put into practice in the ICU. There is room for improvement.