Journal ArticleDOI
Ventilator-associated pneumonia.
Jean Chastre,Jean-Yves Fagon +1 more
TLDR
Appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals.Abstract:
Ventilator-associated pneumonia (VAP) continues to complicate the course of 8 to 28% of patients receiving mechanical ventilation (MV). In contrast to infections of more frequently involved organs (e.g., urinary tract and skin), for which mortality is low, ranging from 1 to 4%, the mortality rate for VAP ranges from 24 to 50% and can reach 76% in some specific settings or when lung infection is caused by high-risk pathogens. The predominant organisms responsible for infection are Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae, but etiologic agents widely differ according to the population of patients in an intensive care unit, duration of hospital stay, and prior antimicrobial therapy. Because appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals. Our personal bias is that using bronchoscopic techniques to obtain protected brush and bronchoalveolar lavage specimens from the affected area in the lung permits physicians to devise a therapeutic strategy that is superior to one based only on clinical evaluation. When fiberoptic bronchoscopy is not available to physicians treating patients clinically suspected of having VAP, we recommend using either a simplified nonbronchoscopic diagnostic procedure or following a strategy in which decisions regarding antibiotic therapy are based on a clinical score constructed from seven variables. Selection of the initial antimicrobial therapy should be based on predominant flora responsible for VAP at each institution, clinical setting, information provided by direct examination of pulmonary secretions, and intrinsic antibacterial activities of antimicrobial agents and their pharmacokinetic characteristics. Further trials will be needed to clarify the optimal duration of treatment and the circumstances in which monotherapy can be safely used.read more
Citations
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Journal ArticleDOI
The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America
John S. Bradley,Carrie L. Byington,Samir S. Shah,Brian Alverson,Edward R. Carter,Christopher J. Harrison,Sheldon L. Kaplan,Sharon E. Mace,George H. McCracken,Matthew R. Moore,Shawn D. St. Peter,Jana A. Stockwell,Jack Swanson +12 more
TL;DR: Eidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery.
Journal ArticleDOI
Weaning from mechanical ventilation
Jean-Michel Boles,Julian Bion,Alfred Connors,Margaret S. Herridge,Brian Marsh,Christian Melot,R. Pearl,Henry Silverman,Michael L. Stanchina,Antoine Vieillard-Baron,Tobias Welte +10 more
TL;DR: An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process and an 11-member international jury answered five pre-defined questions.
Journal Article
Guidelines for Preventing Health-Care-- Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
TL;DR: The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and longterm care institutions) and other facilities where health care is provided.
Journal ArticleDOI
Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.
Jean Chastre,Michel Wolff,Jean-Yves Fagon,Sylvie Chevret,Franck Thomas,Delphine Wermert,Eva Clementi,Jesus Gonzalez,Dominique Jusserand,Pierre Asfar,Dominique Perrin,Fabienne Fieux,Sylvie Aubas +12 more
TL;DR: 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.
Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults
Jean Chastre,Michel Wolff,Jean-Yves Fagon,Sylvie Chevret,Franck Thomas,Delphine Wermert,Eva Clementi,Jesus Gonzalez,Dominique Jusserand,Pierre Asfar,Dominique Perrin,Fabienne Fieux,Sylvie Aubas +12 more
TL;DR: The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown as mentioned in this paper, however, it is known that shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care unit (ICU).
References
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Journal ArticleDOI
The Crisis in Antibiotic Resistance
TL;DR: Mechanisms such as antibiotic control programs, better hygiene, and synthesis of agents with improved antimicrobial activity need to be adopted in order to limit bacterial resistance.
Journal ArticleDOI
The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee.
Jean Louis Vincent,David Bihari,Peter M. Suter,Hajo A. Bruining,Jane White,Marie-Helene Nicolas-Chanoin,Michel Wolff,Robert C. Spencer,Margaret Hemmer +8 more
TL;DR: ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms, and the potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients.
Journal ArticleDOI
Inadequate Antimicrobial Treatment of Infections: A Risk Factor for Hospital Mortality Among Critically Ill Patients
TL;DR: Inadequate treatment of infections among patients requiring ICU admission appears to be an important determinant of hospital mortality, and clinical efforts aimed at reducing the occurrence of inadequate antimicrobial treatment could improve the outcomes of critically ill patients.
Journal ArticleDOI
Nasal Carriage as a Source of Staphylococcus aureus Bacteremia
TL;DR: In this article, the authors examined S. aureus isolates from blood and from nasal specimens to determine whether the organisms in the bloodstream originated from the patient's own flora.
Journal ArticleDOI
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial
Mitra B. Drakulovic,Antoni Torres,Torsten T. Bauer,Jose María Nicolás,Santiago Nogué,Miquel Ferrer +5 more
TL;DR: The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition, especially for patients receivingEnteral nutrition in the supine body position.