(P-493) Comparison and Contrast of Antibiotic Utilization and Outcomes in Hospital-acquired Pneumonia (HAP), Ventilated HAP (vHAP) and Ventilator Associated Pneumonia (VAP) in the United States

Background: Hospital acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are a significant cause of morbidity and mortality. There are limited data that specifically distinguish HAP, VAP and HAP that leads to respiratory failure requiring ventilated (vHAP).

Objectives: To compare patient characteristics, treatment and outcomes for HAP, VAP and vHAP patients.

Methods: A retrospective cross-sectional analysis was conducted using the Premier Healthcare Database (A multicenter US EHR database of >1000 hospitals) from January 2014 to December 2019. Inpatients (aged ≥18 years) with a secondary ICD-9/10-CM diagnosis of pneumonia were identified as HAP patients. HAP patients were further categorized to designate vHAP defined as those with ventilation without VAP diagnosis. Patients with a diagnostic code for VAP and procedure code for ventilation were classified as VAP.

Results: The study population included 97,177 HAP patients, 15,068 vHAP patients, and 14,555 VAP patients. The mean(±SD) age was 66.9 (±16.3), 62.2 (±15.5), and 58.1 (±17.2) years with 52%, 61%, and 65% males for HAP, vHAP, and VAP patients, respectively. The distribution of clinical comorbidities was uniform across the three groups of patients. The mean length of stay was shortest for HAP at 9.9 (±16.9) days followed by vHAP at 21.6 (±43.7), and the longest for VAP at 27.0 (±31.5) days. The mean duration of antibiotic therapy was 5.7 (±5.5), 10.3 (±8.7), and 18.4 (±17.7) days for HAP, vHAP, and VAP encounters, respectively. On average, antibiotic therapy was started on fifth day from admission. The median and IQR of different antibiotics used in patients with HAP, vHAP and VAP were 2 (IQR: 1-3), 3 (IQR: 2-5) and 5 (IQR: 4-7), respectively. There were differences in the mean charges billed for HAP patients: $79,785 (±110,237), vHAP patients: $270,713 (±344,718) and VAP patients: $423,045 (±487,458).

Conclusions: This study confirms the clinical and economic burden associated with HAP and further delineates the additional burden of mechanical ventilation in vHAP and VAP. Antibiotic utilization in vHAP and VAP require further study in order to improve antimicrobial stewardship practices in these patients both in terms of repertoire and quantity of antibiotics utilized.