Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription.

@article{Singh2000ShortcourseEA,
  title={Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription.},
  author={N. Singh and Paul L. Rogers and Charles W. Atwood and Marilyn M. Wagener and Victor L. Yu},
  journal={American journal of respiratory and critical care medicine},
  year={2000},
  volume={162 2 Pt 1},
  pages={
          505-11
        }
}
  • N. Singh, P. Rogers, V. Yu
  • Published 1 August 2000
  • Medicine
  • American journal of respiratory and critical care medicine
Inappropriate antibiotic use for pulmonary infiltrates is common in the intensive care unit (ICU). We sought to devise an approach that would minimize unnecessary antibiotic use, recognizing that a gold standard for the diagnosis of nosocomial pneumonia does not exist. In a randomized trial, clinical pulmonary infection score (CPIS) (Pugin, J., R. Auckenthaler, N. Mili, J. P. Janssens, R. D. Lew, and P. M. Suter. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of… 

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References

SHOWING 1-10 OF 28 REFERENCES
Invasive and Noninvasive Strategies for Management of Suspected Ventilator-Associated Pneumonia
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.
Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid.
TLDR
A good correlation between clinical score and quantitative bacteriology was observed and patients with pulmonary infection could be distinguished by a BI greater than or equal to 5 with a sensitivity of 93% and a specificity of 100% (B-BAL).
Indications for antibiotic use in ICU patients: a one-year prospective surveillance.
TLDR
Almost all antibiotics prescribed were for intubated patients and for BPI, which means that prevention of respiratory tract infections is probably the most effective mode to reduce antibiotic use.
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.
Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996.
TLDR
A working knowledge of the epidemiology and strategies for prevention of VAP should reduce infection rates, morbidity, and mortality in critically ill patients.
Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. The Severe Pneumonia Study Group
TLDR
Monotherapy with ciprofloxacin is at least equivalent to monotherapy with imipenem in terms of bacteriological eradication and clinical response, and for both treatment groups, the presence of P. aeruginosa had a negative impact on treatment success.
Antibiotic usage in an intensive care unit in a Danish university hospital.
TLDR
The study of antimicrobial use in patients admitted to the Intensive Care Unit (ICU) in a Danish university hospital during the course of 1 year emphasizes the need for consultation between surgeons and clinical microbiologists to supervise postoperative antibiotic use.
Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study.
TLDR
The impact of bronchoscopy was to lead to more frequent antibiotic changes with no change in mortality in this pilot study, and there were no statistically significant differences when comparing crude and adjusted mortality rates of Groups A and B.
Pulmonary infiltrates in the surgical ICU: prospective assessment of predictors of etiology and mortality.
TLDR
Pneumonia in trauma patients was significantly more likely to be due to Haemophilus/pneumococcus as compared with all other ICU patients, and these data have implications for treatment of patients with nosocomial pneumonia in the ICU.
Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients.
TLDR
The findings indicate that the use of clinical criteria alone does not permit the accurate diagnosis of nosocomial pneumonia in ventilated patients, and commonly results in inappropriate or inadequate antibiotic therapy for these patients.
...
...