Efficacy of quality improvement interventions on antibiotic prescription practices for ventilator-associated pneumonia at a tertiary care centre: a prospective pre-post interventional study

Abstract

Background: Ventilator-associated pneumonia (VAP) is a prevalent nosocomial infection in the intensive care unit (ICU), significantly increasing patient morbidity, mortality, and healthcare costs. Effective management is essential, particularly in the context of antimicrobial resistance and the frequent use of antibiotics in ICUs.

Methods: This prospective pre-post interventional study was conducted in the medical ICU of a tertiary care centre, over 6 months. Adult patients diagnosed with VAP and receiving antibiotics for more than 48 hours were included. The study involved three phases: preintervention (baseline antibiotic prescription audit), intervention (educational sessions, multidisciplinary meetings and tailored feedback) and postintervention (follow-up audit). Data analysis included Kaplan-Meier survival curves and statistical comparisons of ICU stay durations.

Results: In the preintervention phase, the median treatment duration was 24 days, while the postintervention phase reduced this to 17 days. Kaplan-Meier curves showed improved survival probabilities and shorter ICU stays in the postintervention phase. The mean ICU stay decreased significantly from 24 days preintervention to 11.3 days postintervention (p=0.027). Mortality rates also improved, with 38.5% discharged and 61.5% deaths postintervention, compared with 23.5% discharged and 76.5% deaths preintervention. Antibiotic prescription patterns shifted towards more targeted therapy, adhering better to culture and sensitivity results and reducing the use of broad-spectrum antibiotics and polypharmacy.

Conclusion: Quality improvement interventions significantly improved VAP management by reducing treatment duration, ICU stay and mortality rates. Educational sessions, multidisciplinary collaboration and tailored feedback enhanced antibiotic prescription practices, highlighting the importance of continuous quality improvement in ICU settings. Further research and sustained efforts in antimicrobial stewardship are essential to combat VAP and improve patient outcomes.

Keywords: Antibiotic management; Critical care; Healthcare quality improvement; Nosocomial infections; Quality improvement methodologies.