Study Design and Data Collection

This chart review was approved by the Research Ethics Board, Sunnybrook and Women’s College Health Sciences Centre. All patients with a chart-documented diagnosis of HAP who had been patients at the hospital between January and December 2003 and who had been discharged or had died during this period were eligible for inclusion. Patients with a diagnosis of HAP were identified on the basis of code 486 for pneumonia and type 2 diagnosis (i.e., conditions acquired after admission to hospital) of the International Classification of Diseases revision 10 (ICD-10). For each month of 2003, the charts of 4 or 5 patients who had been discharged in that month were arbitrarily selected by Health Data Resource staff for review, to ensure an even distribution of patients throughout the 2003 calendar year. A total of 50 charts were reviewed.

Information collected from each chart included patient demographic characteristics, past medical history (comorbid conditions and antimicrobial use within 3 months before the diagnosis of HAP), choice of empiric antimicrobial regimen, culture and sensitivity results, changes in treatment regimen, duration of therapy, clinical outcome, and length of hospital stay. The medical or surgical service to which the patient had been admitted was documented to facilitate comparison of microbiological data between the critical care setting and the ward setting. Resolution of HAP was assessed by the following criteria:

  • clinical outcome (cure assessed by chart docu­mentation of resolution of fever, cough, sputum purulence and volume, and leukocytosis and discontinuation of antimicrobials versus death due to infection versus death due to any cause)
  • culture and sensitivity results (eradication of causative pathogens or need to change antimicro­bial therapy)
  • resolution (improvement in pulmonary infiltrate on chest radiography)
    Apcalis Oral Jelly

Statistical Analysis

A convenience sample of 50 patients (15%) was selected from the 325 patients in whom HAP was diag­nosed during the period January 1 to December 31, 2003. Descriptive statistics, including measures of central tendency (mean, median, mode) and measures of vari­ation (standard deviation), were calculated (using Microsoft Excel 2000).