Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.

@article{2005GuidelinesFT,
  title={Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.},
  author={古谷 良輔 and 山口 和将},
  journal={American journal of respiratory and critical care medicine},
  year={2005},
  volume={171 4},
  pages={
          388-416
        }
}
Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points… 

Impact of Hospital-Acquired Pneumonia (HAP) Guidelines on Outcome

TLDR
Implementing guidelines on HAP in daily practice requires extensive institutional support, design of effective campaigns for the diffusion of guidelines to all professionals involved in the day-to-day care of these critically ill patients, and sufficient resources for the monitoring of adherence to guidelines and assessment of the impact of guidelines on indicators of the quality of care.

Antimicrobial treatment of ventilator-associated pneumonia.

TLDR
This de-escalation strategy ensures adequate initial antimicrobial therapy for most patients but lessens unnecessary antimicrobial exposure, and the roles of combination therapy, rotating therapy, and unconventional approaches to antimicrobial Therapy all remain uncertain.

Diagnosis, Management and Prevention of Ventilator-Associated Pneumonia

TLDR
Management of VAP relies principally on appropriate antimicrobial therapy, which should be selected according to individual patient factors, such as previous antibacterial therapy and length of hospitalization or mechanical ventilation, and local infection and resistance patterns.

Management of ventilator-associated pneumonia caused by multiresistant bacteria

TLDR
With the use of broad-spectrum antibiotics available in empiric therapy tailored after reassessment of the patient, there is hope for reducing costs, length of stay and mortality whereas the emergence of resistance will be minimized.

Identifying missed opportunities to curtail antimicrobial therapy for presumed ventilator-associated pneumonia using the clinical pulmonary infection score.

TLDR
A significant opportunity exists at the authors' institution to develop and implement an antimicrobial discontinuation policy that uses the clinical pulmonary infection score to guide antimicrobial use for patients with ventilator-associated pneumonia.

Should the ATS/IDSA Guidelines for Hospital-acquired and Ventilator-associated Pneumonia be Reevaluated?

We have revised the effects of implementing the current and former guidelines for the management and treatment of ventilator-associated pneumonia (VAP) on the outcome of intensive care unit patients,

Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia

TLDR
Across Europe, carbapenems were the antibiotic most prescribed for HAP/VAP, and appropriate empirical antibiotics decreased ICU length of stay by 6 days, which was the major determinants of antibiotic choice at the bedside.

Current Concepts in the Prevention and Treatment of Ventilator-Associated Pneumonia

TLDR
De-escalation of therapy should be a constant focus in an attempt to reduce overall antibiotic consumption and the selection pressure on ICU flora, thus minimizing the development and spread of antimicrobial resistance in the ICU.

Pharmacotherapy for hospital-acquired pneumonia

TLDR
A continuous evaluation of the antimicrobial therapeutic options, along with their pharmacodynamic and pharmacokinetic profiles, is mandatory to optimize therapy and reduce hospital pneumonia-related mortality.

An Argument for the Use of Aminoglycosides in the Empiric Treatment of Ventilator-Associated Pneumonia.

  • A. May
  • Medicine, Biology
    Surgical infections
  • 2016
TLDR
In patients at high risk of infection with antibiotic-resistant gram-negative bacilli and in those with severe illness, aminoglycosides improve clinical outcomes and in critically ill populations, short-duration therapy and high-dose extended-interval dosing can improve therapeutic efficacy while limiting nephrotoxicity.
...

References

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TLDR
Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality.

Variability in antibiotic prescribing patterns and outcomes in patients with clinically suspected ventilator-associated pneumonia.

TLDR
Patients with clinically suspected VAP who receive initial empiric therapy with antipseudomonal penicillins plus beta-lactamase inhibitors, and possibly aminoglycosides, have lower in-hospital mortality rates when compared with those who are not treated with these antibiotics.

Diagnosis and treatment of ventilator-associated pneumonia--impact on survival. A decision analysis.

TLDR
Invasive or semi-invasive diagnostic techniques should be used to diagnose VAP, guide therapy, and thereby potentially improve survival and a prospective, randomized trial assessing outcome according to diagnostic technique is needed.

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TLDR
Although patients with VAP caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when antimicrobial therapy lasted only 8 days, they did have a higher pulmonary infection-recurrence rate compared with those receiving 15 days of treatment.

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TLDR
The application of a clinical guideline for the treatment of ventilator-associated pneumonia can increase the initial administration of adequate antimicrobial treatment and decrease the overall duration of antibiotic treatment.

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TLDR
To test the hypothesis that an invasive management strategy is superior to a clinical, noninvasive one in terms of improving clinical outcomes and minimizing antibiotic use, a multicenter, randomized, uncontrolled trial is initiated to compare these strategies in patients suspected of having ventilator-associated pneumonia.

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TLDR
Clinicians can improve antimicrobial treatment by using empirical combination antibiotic therapy based on individual patient characteristics and the predominant bacterial flora and their antibiotic susceptibility profiles, and this broad-spectrum therapy can be narrowed when initial culture results are received.

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TLDR
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TLDR
The prescription of empirical antimicrobial Therapy by a senior physician in agreement with practice guidelines made it possible to achieve a crude rate of 89% of adequate antimicrobial therapy in study patients, which was associated with a 39% excess of mortality.

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TLDR
It is concluded that antimicrobial therapy should be targeted toward "nosocomial" pathogens in those institutionalized patients who received prior antibiotic treatment, and direct visualization of the tracheobronchial tree might be useful in determining the presence of bacterial pneumonia.
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