B-VAP occurs later during intensive care unit stay, is more frequent in previously hospitalized patients, is more often caused by methicillin-resistant S. aureus, and is independently associated with increased intensive care unit mortality.
Despite appropriate glycopeptide therapy, there is an increased attributable mortality for pneumonia by ORSA, after careful adjustment for disease severity and diagnostic category.
As ventilator-associated pneumonia increases, empiric therapy should be based on local pathogen etiology and antibiotic resistant patterns. A new approach to consider is to start with a high-dose, broad-spectrum antibiotic and then tailor the individual therapy based on microbiological results and clinical resolution. 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.
IntroductionFew cases of pulmonary toxicity related to epidermal growth factor receptor-targeted agents have been described.Case presentationWe report a case of a 63-year-old white male with stage IV non-small cell lung cancer treated with erlotinib who developed a interstitial lung disease.ConclusionRespiratory symptoms during treatment with erlotinib should alert clinicians to rule out pulmonary toxicity. Early erlotinib withdrawal and corticoid administration were successful.
BackgroundThe inappropiate use of antibiotics is leading to the appearance of resistance that, along with the decline in the development of new antibacterials, makes some experts talk about a future post-antibiotic period. Approximately between 80% and 90% of antibiotics use occurs in outpatients. It is estimated that about half of the antibiotic prescriptions in outpatients are inappropriate due either to antibiòtic selection, dosage or duration.PurposeThe primary objective of the project is to measure the impact of a multimodal intervention on the use of antibiotics in the emergency department (ED) of a primary care area (PCA).Material and methodsProspective study with intervention in ED of a PCA (population: 260,517) from January to June 2017. Recorded variables: defined daily dose (DDD) of amoxicillin, amoxicillin/clavulanic, macrolides, quinolones and other antibiotics from January to June 2017. The information was extracted from patients’ medical prescriptions.Intervention1) Emergency physiciansa) Commitment: The programme was presented to the head of the ED medical service, emergency physicians and primary care centre directors, through face-to-face sessions. Poster reminders of the project were placed in medical consultations and the ED.b) Actions directed to improve the prescription of antibiotics: An antimicrobial stewardship guideline was designed with local antimicrobial recommendations.c) Audit and feedback: Information was provided to emergency physicians, with their antimicrobial consumption rate establishing a comparison between physicians and the ED average.d) Education and experience: Interactive clinical sessions were held on different pathologies included in the antimicrobial stewardship programme.2) PatientsPosters and educational brochures for waiting rooms and consultations were designed.ResultsFrom January to June 2017 total antibiotic use was reduced by 14.4% DDD compared to the same period of 2016. A decrease in the main families of antibiotics was observed: 22.42% amoxicillin, 6.89% amoxicillin/clavulanic, 21.96% macrolides, 32.42% quinolones and 1.73% of other antibiotics.ConclusionThe strategy designed to improve the use of antibiotics in the ED of the PCA led to a decrease in antibiotic consumption.References and/or AcknowledgementsNo acknowledgementsNo conflict of interest
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