• Jan Brozek, Ellen McDonald, France Clarke, Carolyn Gosse, Roman Jaeschke, and Deborah Cook.
• Jagiellonian University School of Medicine and Polish Institute for Evidence Based Medicine, Krakow, Poland.
• Am. J. Crit. Care. 2007 May 1; 16 (3): 214-9.

BackgroundLittle information is available on the types, causes, and treatment of pneumonia in intensive care unit patients in usual clinical practice.ObjectiveTo characterize treatment of patients with presumed pneumonia in a tertiary care intensive care unit and to identify potential areas for improvement in care.MethodsIn a prospective, cohort study, the sample consisted of all consecutive patients treated in an intensive care unit during a 3-month period. For patients with presumed pneumonia, data were collected on incidence of pneumonia, diagnostic investigations, microbial isolates, and antibiotics prescribed.ResultsOf 194 admissions, 73 patients were treated for pneumonia: 47 had community-acquired pneumonia; 12 had hospital-acquired pneumonia; 12 had ventilator-associated pneumonia, both early (7) and late (5); and 2 had intensive care unit-acquired pneumonia. Approximately 71% of patients had microbiological tests performed. Among 54 microbial isolates, 51.9% were gram-positive bacteria, 31.5% were gram-negative bacteria, and 9.3% were Candida species. The most commonly used antimicrobials were quinolones (54 of 192 prescriptions) and cephalosporins (33); each patient received a median of 3 antibiotics.ConclusionsMost cases of pneumonia were community acquired. The most common causative organisms were gram-positive cocci. Four quality improvement strategies were rationalization of antibiotic use during rounds, nurses' reporting of culture results, review of antibiotic appropriateness by a pharmacist, and redesign of the clinical information system.

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