Brief summary of French guidelines for the prevention, diagnosis and treatment of hospital-acquired pneumonia in ICU (original) (raw)
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Hospital-acquired pneumonia in ICU
Anaesthesia, critical care & pain medicine, 2018
The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%....
Clinical Infectious Diseases, 2010
Background. The 2005 guidelines of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital for managing hospital-acquired pneumonia classified patients according to time of onset and risk factors for potentially drug-resistant microorganisms to select the empirical antimicrobial treatment. We assessed the microbial prediction and validated the adequacy of these guidelines for antibiotic strategy. Methods. We prospectively observed 276 patients with intensive care unit-acquired pneumonia. We classified patients into group 1 (early onset without risk factors for potentially drug-resistant microorganisms; 38 patients) and group 2 (late onset or risk factors for potentially drug-resistant microorganisms; 238 patients). We determined the accuracy of guidelines to predict causative microorganisms and the influence of guidelines adherence in patients' outcome. Results. Microbial prediction was lower in group 1 than in group 2 (12 [50%] of 24 vs 119 [92%] of 129; P ! .001) mainly because of potentially drug-resistant microorganisms in 10 patients (26%) from group 1. Guideline adherence was higher in group 2 (153 [64%] vs 7 [18%]; P ! .001). Guideline adherence resulted in more treatment adequacy than did nonadherence (69 [83%] vs 45 [64%]; P p .013) and a trend toward better response to empirical treatment in group 2 only but did not influence mortality. Reclassifying patients according to the risk factors for potentially drug-resistant microorganisms of the former 1996 American Thoracic Society guidelines increased microbial prediction in group 1 to 21 (88%; P p .014); all except 1 patient with potentially drug-resistant microorganisms were correctly identified by these guidelines. Conclusions. The 2005 guidelines predict potentially drug-resistant microorganisms worse than the 1996 guidelines. Adherence to guidelines resulted in more adequate treatment and a trend to a better clinical response in group 2, but it did not influence mortality. Hospital-acquired pneumonia (HAP) is a frequent and severe infection in intensive care units (ICU), with important morbidity, mortality, and economic cost [1-3]. Although the mortality rate has decreased in recent years, it is still substantial [4]. The institution of a timely and appropriate antimicrobial therapy is crucial to decrease the rates of com
Advances in the management of pneumonia in the intensive care unit: review of current thinking
Clinical Microbiology and Infection, 2005
Interventions to prevent pneumonia in the intensive care unit should combine multiple measures targeting the invasive devices, microorganisms and protection of the patient. Microbiological investigation is useful for evaluating the quality of the respiratory sample, and permits early modification of the regimen in light of the microbiological findings. Once pneumonia develops, the appropriateness of the initial antibiotic regimen is a vital determinant of outcome. Three questions should be formulated: (1) is the patient at risk of acquiring methicillin-resistant Staphylococcus aureus, (2) is Acinetobacter baumannii a problem in the institution, and (3) is the patient at risk of acquiring Pseudomonas aeruginosa? Antibiotic therapy should be started immediately and must circumvent any pathogen resistance mechanisms developed after previous antibiotic exposure. Therefore, antibiotic choice should be institution-specific and patient-oriented.
Infection and Drug Resistance
Introduction: Management of ventilator-associated pneumonia (VAP), the most common infection in patients on mechanical ventilation, should be tailored to local microbiological data. The aim of this study was to determine susceptibility patterns of organisms causing VAP to develop a treatment algorithm based on these findings and evidence from the literature. Materials and methods: This is a retrospective analysis of the microbiological etiology of VAP in the intensive care unit (ICU) of a Lebanese tertiary care hospital from July 2015 to July 2016. We reviewed the latest clinical practice guidelines on VAP and tried to adapt these recommendations to our setting. Results: In all, 43 patients with 61 VAP episodes were identified, and 75 bacterial isolates caused VAP. Extensively drug-resistant (XDR) Acinetobacter baumannii was the most common organism (37%), and it had occurred endemically throughout the year. Pseudomonas aeruginosa was the next most common organism (31%), and 13% were XDR. Enterobacteriaceae (15%) and Stenotrophomonas maltophilia (12%) shared similar incidences. Our algorithm was based on guidelines, in addition to trials, systematic reviews, and meta-analyses that studied the effectiveness of available antibiotics in treating VAP. Conclusion: Knowing that resistance can rapidly develop within a practice environment, more research is needed to identify the best strategy for the management of VAP.
Journals International Journal of Pharmacy and Pharmaceutical Sciences, 2024
Objective: This study was conducted to investigate the antibiotic usage, risk factors and mortality associated with the development of VAP (Ventilator Associated Pneumonia). Methods: An open-labelled, prospective, observational (case-control) study was carried out for 6 mo in the Department of Critical Care Medicine. Initial screening was done based on inclusion and exclusion criteria and 58 patients were found eligible. The statistical analysis was done using the Chi-Square test and t-test. Results: The incidence of VAP in our study was 6.07%. Prolonged hospitalisation (p=0.00) and ICU stay (p=0.00) showed a statistically significant association with the development of VAP and they possessed a high risk of carbapenem-resistant organisms in the age group more than 60 years. Colistin therapy alone and/or combined with tigecycline therapy showed 100% survival. SOFA (Sequential Organ Failure Assessment) scoring done before and after VAP diagnosis showed a significant difference (p<0.005). Our study revealed that mortality was high in patients with SOFA score range of 7-9. Conclusion: The lower incidence of VAP points out the good infection control practices in the ICU (Intensive Care Unit). Late-onset VAP was more prevalent with Acinetobacter baumannii. Prolonged hospitalization and ICU stay were the significant risk factors. Colistin therapy alone and/or in combination with tigecycline was the most effective treatment.
Prevention of hospital-acquired pneumonia in critically ill patients
Antimicrobial Agents and Chemotherapy, 1993
Hospital-acquired pneumonia causes considerable morbidity and mortality and adds appreciably to the costs of health care (40, 69). Pneumonia accounts for approximately 10 to 15% of hospital-acquired infections, and mortality rates range from 15 to 50% (5, 24, 37, 40, 69), although the rates of mortality directly attributable to pneumonia may be lower (40). Facultative gram-negative bacilli are isolated in 40 to 60% of these infections (5, 9, 12, 24, 37). Risk factors for colonization and infection of the respiratory tract by facultative gram-negative rods include intubation and tracheostomy, severe underlying disease, especially chronic lung disease, prolonged hospitalization, prior aspiration of gastric contents, and exposure to antibiotics (5, 12, 18, 30, 42, 59, 69). Since gram-negative bacilli account for a major portion of isolates in hospital-acquired pneumonia, efforts to prevent this infection have focused on the elimination of these pathogens. These efforts have been aimed at the elimination of exogenous sources of gram-negative organisms by encouraging regular hand washing by health care workers, the use of aseptic techniques for tracheal suction, and the sterilization of respiratory equipment (37). Although these efforts have had an impact, nosocomial pneumonia remains a major problem. Recently, the focus of intervention has shifted from exogenous sources to the patient's fecal flora as a potential source of gram-negative bacilli that may colonize the nasopharynx and cause pneumonia. This shift has led to renewed interest in the use of topical and systemic antimicrobial prophylaxis to prevent pneumonia. The purpose of this review is to examine the assumptions that underlie the use of antimicrobial prophylaxis to prevent nosocomial pneumonia and to review the results of comparative studies in terms of the efficacy and risks of prophylaxis. The lack of a "gold standard" for the diagnosis of hospitalacquired pneumonia as well as variability in the definition of nosocomial pneumonia makes a comparative analysis of prophylaxis studies difficult. Differences in the patient populations studied provide a source of sample bias that makes generalization of the study results problematic. The focus of this review will be on critically ill or high-risk patients, i.e., patients requiring intensive care unit (ICU) admission and, frequently, mechanical ventilation, because these patients have been the most carefully studied population. Neutropenic patients, who constitute a separate risk group, will not be considered here.
Hospital-acquired pneumonia in icu patients
Biomedical Papers, 2011
Background. This prospective study aimed at assessing the effect of initial antibiotic therapy on the mortality of patients with hospital-acquired pneumonia (HAP) by analyzing bacterial pathogens and their resistance to antimicrobial agents. Methods. Included were patients hospitalized in the
Antibiotics
Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP r...