Ventilator-associated pneumonia in a multi-hospital system: differences in microbiology by location

Infect Control Hosp Epidemiol. 2003 Nov;24(11):853-8. doi: 10.1086/502149.


Objective: To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.

Design: Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.

Setting: Three hospitals--one pediatric teaching hospital, one adult teaching hospital, and one community hospital--in one healthcare system in the midwestern United States.

Patients: Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available.

Results: Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs.

Conclusions: Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cohort Studies
  • Cross Infection / microbiology*
  • Cross Infection / transmission
  • Equipment Contamination*
  • Escherichia coli / isolation & purification
  • Escherichia coli / pathogenicity
  • Hospitals, Community / statistics & numerical data
  • Hospitals, Pediatric / statistics & numerical data
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Illinois / epidemiology
  • Klebsiella pneumoniae / isolation & purification
  • Klebsiella pneumoniae / pathogenicity
  • Missouri / epidemiology
  • Multi-Institutional Systems / statistics & numerical data*
  • Pneumonia, Bacterial / epidemiology
  • Pneumonia, Bacterial / microbiology*
  • Pseudomonas aeruginosa / isolation & purification
  • Pseudomonas aeruginosa / pathogenicity
  • Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / pathogenicity
  • Ventilators, Mechanical / microbiology*