PT - JOURNAL ARTICLE AU - J. Rello AU - M. Ulldemolins PharmD AU - T. Lisboa AU - D. Koulenti AU - R. Mañez AU - I. Martin-Loeches AU - J.J. De Waele AU - C. Putensen AU - M. Guven AU - M. Deja AU - E. Diaz TI - Determinants of Choice and Prescription Patterns in Empiric Antibiotic Therapy for HAP/VAP AID - 10.1183/09031936.00093010 DP - 2010 Jan 01 TA - European Respiratory Journal PG - erj00930-2010 4099 - http://erj.ersjournals.com/content/early/2010/09/16/09031936.00093010.short 4100 - http://erj.ersjournals.com/content/early/2010/09/16/09031936.00093010.full AB - To assess determinants of empirical antibiotic choice, prescription patterns and outcomes in patients with HAP/VAP in Europe.Prospective, observational, cohort study in 27 ICUs from 9 European countries. One hundred consecutive patients in mechanical ventilation (MV) for HAP, on MV >48 hours or with VAP were enrolled per ICU.Admission category, sickness severity and Acinetobacter spp prevalence>10% in pneumonia episodes determined antibiotic empirical choice. Trauma patients were prescribed more often with non-anti-Pseudomonas cephalosporins (OR=2.68; 95%CI 1.50–4.78). Surgical patients received less aminoglycosides (OR=0.26, 95%CI 0.14–0.49). A significant correlation (p<0.01) was found between SAPS II score and carbapenem prescription. Basal Acinetobacter spp prevalence >10% dramatically increased the prescription of carbapenems (OR=3.5, 95%CI 2.0–6.1) and colistin (OR=115.7, 95%CI 6.9–1930.9). Appropriate empiric antibiotics decreased ICU LOS by 6 days (26.3±19.8 vs. 32.8±29.4days, p=0.04). Most prescribed antibiotics were carbapenems, piperacillin/tazobactam and quinolones. Median duration of antibiotic therapy was 9 days (IQR 6–12). Anti-MRSA agents were prescribed in 38.4% of VAP episodes.Admission category, sickness severity and basal Acinetobacter prevalence>10% in pneumonia episodes were major determinants of antibiotic choice at the bedside. Carbapenems were the most prescribed antibiotics for HAP/VAP across Europe.