Clinical aspiration-related practice patterns in the intensive care unit: A physician survey

J. A. Rebuck, J. R. Rasmussen, Keith Melvin Olsen

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

Objective: To characterize physician practice patterns regarding the clinical, microbiological, and antimicrobial-related events of suspected or documented aspiration and aspiration pneumonia within the intensive care unit. Design: National mail survey. Setting: University medical center. Study Population: Critical care physician members of the Society of Critical Care Medicine. Interventions: Survey questionnaire. Measurements and Main Results: The response rate was 645 (32%) of 2,000 mailed surveys; analysis of data represents completed questionnaires from 605 respondents. Intensivists (42.3%), pulmonologists (22.6%), and surgeons (21.6%) represent the majority of respondents. Altered level of consciousness (67.9%) in the intensive care unit was identified as the predominant predisposing factor for aspiration pneumonia. Sixty-four percent of physicians used sputum specimens, rather than protected specimen brushes or bronchoalveolar lavage, as the diagnostic source of bacterial cultures in cases of suspected aspiration pneumonia. Microbiological assessment of aspiration pneumonia revealed the absence of any predominant pathogen, although Staphylococcus aureus and Pseudomonas aeruginosa were cited in 40.1% of combined responses, whereas anaerobes represented the fifth most prevalent cultured bacteria. In cases of suspected and confirmed aspiration, 51.9% and 77.7% of respondents, respectively, would prescribe an antimicrobial agent in the absence of a definitive infectious process, with administration of dual antimicrobial therapy increasing from 28.9% to 46.0% in suspected vs. confirmed cases of aspiration. In the treatment of aspiration pneumonia, 27.6% of physicians preferred pathogen-specific therapy, whereas the remainder (72.4%) selected an empirical antibiotic regimen based on prior clinical experience. Overall, a β-lactam/β-lactamase inhibitor, followed by a cephalosporin, aminoglycoside in combination, or clindamycin, was most often selected for empirical therapy of all defined aspiration-related clinical diagnoses. Conclusions: Our study revealed a divergent approach to antimicrobial treatment of cases of aspiration in the intensive care unit. Further investigation is warranted to determine why empirical antimicrobials are initiated frequently for noninfectious stages of aspiration.

Original languageEnglish (US)
Pages (from-to)2239-2244
Number of pages6
JournalCritical care medicine
Volume29
Issue number12
DOIs
StatePublished - Jan 1 2001

Fingerprint

Aspiration Pneumonia
Intensive Care Units
Physicians
Physicians' Practice Patterns
Consciousness Disorders
Therapeutics
Lactams
Clindamycin
Postal Service
Aminoglycosides
Bronchoalveolar Lavage
Cephalosporins
Critical Care
Anti-Infective Agents
Surveys and Questionnaires
Aspirations (Psychology)
Sputum
Causality
Pseudomonas aeruginosa
Staphylococcus aureus

Keywords

  • Antibiotic
  • Antimicrobial
  • Aspiration
  • Aspiration pneumonia
  • Clinical aspiration
  • Critical care
  • Intensive care
  • Intensivist
  • Microbiology
  • Survey

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Clinical aspiration-related practice patterns in the intensive care unit : A physician survey. / Rebuck, J. A.; Rasmussen, J. R.; Olsen, Keith Melvin.

In: Critical care medicine, Vol. 29, No. 12, 01.01.2001, p. 2239-2244.

Research output: Contribution to journalReview article

Rebuck, J. A. ; Rasmussen, J. R. ; Olsen, Keith Melvin. / Clinical aspiration-related practice patterns in the intensive care unit : A physician survey. In: Critical care medicine. 2001 ; Vol. 29, No. 12. pp. 2239-2244.
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abstract = "Objective: To characterize physician practice patterns regarding the clinical, microbiological, and antimicrobial-related events of suspected or documented aspiration and aspiration pneumonia within the intensive care unit. Design: National mail survey. Setting: University medical center. Study Population: Critical care physician members of the Society of Critical Care Medicine. Interventions: Survey questionnaire. Measurements and Main Results: The response rate was 645 (32{\%}) of 2,000 mailed surveys; analysis of data represents completed questionnaires from 605 respondents. Intensivists (42.3{\%}), pulmonologists (22.6{\%}), and surgeons (21.6{\%}) represent the majority of respondents. Altered level of consciousness (67.9{\%}) in the intensive care unit was identified as the predominant predisposing factor for aspiration pneumonia. Sixty-four percent of physicians used sputum specimens, rather than protected specimen brushes or bronchoalveolar lavage, as the diagnostic source of bacterial cultures in cases of suspected aspiration pneumonia. Microbiological assessment of aspiration pneumonia revealed the absence of any predominant pathogen, although Staphylococcus aureus and Pseudomonas aeruginosa were cited in 40.1{\%} of combined responses, whereas anaerobes represented the fifth most prevalent cultured bacteria. In cases of suspected and confirmed aspiration, 51.9{\%} and 77.7{\%} of respondents, respectively, would prescribe an antimicrobial agent in the absence of a definitive infectious process, with administration of dual antimicrobial therapy increasing from 28.9{\%} to 46.0{\%} in suspected vs. confirmed cases of aspiration. In the treatment of aspiration pneumonia, 27.6{\%} of physicians preferred pathogen-specific therapy, whereas the remainder (72.4{\%}) selected an empirical antibiotic regimen based on prior clinical experience. Overall, a β-lactam/β-lactamase inhibitor, followed by a cephalosporin, aminoglycoside in combination, or clindamycin, was most often selected for empirical therapy of all defined aspiration-related clinical diagnoses. Conclusions: Our study revealed a divergent approach to antimicrobial treatment of cases of aspiration in the intensive care unit. Further investigation is warranted to determine why empirical antimicrobials are initiated frequently for noninfectious stages of aspiration.",
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