At the authors’ institution, the currently recommended choice of empiric therapy for HAP in patients outside the intensive care unit is ceftriaxone. However, this recommendation is not being followed. Levofloxacin 500 mg daily was in fact the most commonly prescribed empiric therapy for HAP. At the time of this study, levofloxacin did not appear in the institution’s HAP management guidelines. However, in a recently published evaluation, West and others concluded that levofloxacin 750 mg daily was at least as effective and well tolerated as imipenem-cilastatin followed by oral ciprofloxacin for the treatment of nosocomial pneumonia in adults. Although the small retrospective analysis reported here indicates that levofloxacin 500 mg daily may be effective in the treatment of nosocomial pneumonia, confirmation of these results with a prospective, randomized design (comparing levofloxacin 500 mg daily and levofloxacin 750 mg daily) to assess microbiological outcome, clinical outcome, safety, and risk of organisms developing resistance would be necessary before any recommen­dations could be made concerning the use of levofloxacin 500 mg for HAP.

Antimicrobial susceptibility surveillance data for this institution showed rising resistance in Klebsiella pneumonia, Enterobacterspp., and Serratia marcescens. In contrast, the results reported here indicate that of these potentially problematic organisms, only Serratia marcescens caused HAP with an incidence of greater than 5%. At this time, it does not appear that either Klebsiella pneumoniae or Enterobacter spp. are com­monly implicated as causes of HAP at this institution. The only bacteria seen in more than 15% of sputum culture samples were MSSA (3/19 or 16% of samples), Hemophilus influenzae (4/19 or 21% of samples), and Serratia marcescens (3/19 or 16% of samples). Sensitivity testing of Serratia marcescens to ceftriaxone is no longer reported at this institution because ceftriax- one would not routinely be selected for use against this pathogen. There were no outbreaks of problematic bacteria (e.g., MRSA or extended-spectrum £-lactamase- producing gram-negative bacilli [ESBL]) during this study.
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Although either ceftriaxone or levofloxacin appears to be a reasonable initial empiric agent for the management of HAP at this institution, the findings of MSSA and Serratia marcescens in 16% of positive cultures indicate that culture and sensitivity information may be important in guiding antimicrobial management. Given the sensitivity profiles of the 3 organisms seen most often in patients with HAP at this institution, multidrug-resistant strains are not yet a concern. There­fore, it is not yet necessary to broaden the current spectrum of empiric coverage to include agents active against multidrug-resistant bacteria (e.g., carbapenems).

All-cause mortality in the patients reviewed was approximately 32%, which is in keeping with HAP-attributed mortality figures of 33% to 50% reported elsewhere. The mortality attributable to HAP could not be determined because information regarding the cause of death was not consistently documented in the charts.

The major limitations of this study were the retrospective design and the small sample size.

In conclusion, the most commonly identified causes of HAP at this institution were Staphylococcus aureus, Hemophilus influenzae, and Serratia marcescens. Multidrug-resistant strains of these organisms are not yet a concern. Therefore, broad- spectrum antibiotics, such as carbapenems, ceftazidime, and buy ciprofloxacin online, should not be used in the routine empiric management of ward patients with HAP at the authors’ institution at this time. This study highlights the importance of incorporating antimicrobial use patterns, patient demographic characteristics, and occurrence of pathogenic organisms and their antimicrobial susceptibility in the development of institution-specific recommendations for the treatment of HAP. A larger interventional study is needed to assess the clinical efficacy of levofloxacin 500 mg daily for HAP. eriacta 100 mg