Nosocomial pneumonia in the intensive care unit: how should treatment failure be predicted

Ranzani, Otávio T.; Prina, Elena; Torres, Antoni

doi:10.5935/0103-507x.20140032

Cited by 7 publications

(4 citation statements)

References 16 publications

(32 reference statements)

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“…Hospital-acquired pneumonia (HAP), including VAP, the most common infection in the ICU, is associated with prolonged hospital and ICU stays, high costs and poor outcomes (11). Studies, including a prospective 1-year microbiological study, showed that antibiotic-resistant bacteria are one of the proven causes of high mortality rates in pneumonia (12).…”

Section: Discussionmentioning

confidence: 99%

Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

et al. 2020

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Because of an increased prevalence of infections with resistant Gram-negative bacteria, finding optimal treatment regimens for these cases is one of the major healthcare concerns. Providencia is a Gram-negative bacteria belonging to the Enterobacteriaceae family. This article aims to describe an effective antibacterial regimen used for treating ventilator-associated pneumonia (VAP) with species of Providencia that are resistant to all antimicrobial classes. We present the case of a 74-year-old woman suffering from VAP caused by pandrug-resistant Providencia. The patient received high-dose intravenous meropenem (1 g every 12 h, infused over 4 h), intravenous amikacin (1,500 mg every 48 h) and nebulised amikacin (250 mg every 6 h). The dosages were calculated based on weight and renal function (GFR = 13.69 ml/min/1.73). After 23 days of treatment, following improvement in clinical signs (including fever), a drop in leucocytes counts, a higher than 80% reduction in procalcitonin levels (0.12), together with confirmed microbial eradication (negative sputum cultures), the antibacterial regimen was discontinued. In conclusion, when dealing with an infection with a pan-resistant microorganism, using combinations of antibiotics in high doses can be an option. These treatment regimens have the potential of overcoming in vitro resistance, leading to clinical improvement and microbial eradication.

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Section: Discussionmentioning

confidence: 99%

Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

et al. 2020

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“…A pneumonia nosocomial é considerada a segunda infecção mais comum em hospitais, e que faz parte dos maiores índices de mortalidade (Ranzani et al, 2014). Com isso, é necessária uma boa conduta do cirurgião dentista na UTI, a fim de limitar o agravamento dos pacientes por meio de infecções propagadas através da cavidade bucal (Soares et al, 2022).…”

Section: O Que é Pneumonia Nosocomial E Qual a Conduta Do Cirurgião-d...unclassified

“…A Pneumonia Nosocomial é uma infecção caracterizada por um infiltrado pulmonar que se desenvolve após a admissão do paciente em Unidade de terapia intensiva (Ranzani et al, 2014). Esta infecção ocorre através da entrada de microrganismos no trato respiratório inferior (Pulmão, brônquios e traqueia) durante a aspiração de secreção da orofaringe, que em casos de pacientes intubados, a secreção se acumula acima do balonete do tubo, que tem a função de impedir a aspiração e a expiração, fazendo com que esse fluxo de ar aconteça através da cânula endotraqueal (Souza et al, 2020).…”

Section: Introductionunclassified

Pneumonia nosocomial: Impacto do Cirurgião-Dentista na Unidade de Terapia Intensiva (UTI)

Cabral,

Silva,

Silva

et al. 2023

RSD

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A pneumonia nosocomial é uma infecção do trato respiratório adquirida na Unidade de Terapia Intensiva (UTI), na maioria das vezes após as primeiras 48h de intubação do paciente. O cirurgião-dentista se inclui a partir do momento em que favorece uma manutenção bucal, onde o paciente está incapacitado de realizar tarefas básicas, como a higiene bucal diária. A fragilidade do paciente submetido a internação permite que ele se torne mais vulnerável a disseminação de bactérias, ocasionando complicações que colocam sua vida em risco. Essa revisão de literatura buscou mostrar a importância da inclusão do profissional da odontologia na equipe multidisciplinar. A metodologia deste trabalho foi realizada através de pesquisas de artigos científicos que comprovam a importância da implementação do cirurgião-dentista nas UTI´s, obtendo-se resultados que validam que a prevenção feita por meio de higiene bucal nos pacientes acamados, apontam uma diminuição significativa na quantidade de casos que possivelmente evoluiriam para pneumonia nosocomial.

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“…Signs and symptoms of VAP should improve in the first 6 days after starting adequate antibiotic therapy. Fever and oxygenation may improve as soon as 3 to 5 days, 5 6 7 8 9 while leukocytosis may normalize after 8 days and radiographic changes may persist for weeks. Several conditions can affect the resolution of VAP.…”

mentioning

confidence: 99%

Defining Clinical and Microbiological Nonresponse in Ventilator-Associated Pneumonia

Ceccato

Torres

2022

Semin Respir Crit Care Med

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Ventilator-associated pneumonia (VAP) is a severe complication of mechanical ventilation, with mortality reduced most effectively by adequate early antibiotic treatment. The clinical and microbiologic response can be assessed easily from 72 hours after starting antibiotic treatment. Evidence of nonresponse is based on several factors: (1) lack of clinical improvement, (2) radiographic progression, (3) an impaired Sequential Organ Failure Assessment (SOFA) score, (4) no improvement by days 3 to 5 on the Clinical Pulmonary Infection Score (CPIS), (5) no decreased in biomarkers on day 3, and (6) isolation of a new pathogen on day 3. Among the clinical markers of treatment failure, physicians should consider no improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), persistence of fever or hypothermia, persistence of purulent respiratory secretions, and new-onset septic shock or multiple-organ dysfunction syndrome. Microbiological isolation of a new pathogen on day 3 is also associated with higher mortality, but persistence of the original pathogen does not seem to be associated with a worse prognosis. The real impact of changes to treatment after diagnosing nonresponsive VAP is unknown. Physicians must evaluate whether treatments are adequate in terms of sensitivity, dose, and route. Pharmacokinetically and pharmacodynamically optimized doses are recommended in these patients. Clinical stabilization of comorbidities or underlying conditions may be of benefit.

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Nosocomial pneumonia in the intensive care unit: how should treatment failure be predicted

Cited by 7 publications

References 16 publications

Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

Pneumonia nosocomial: Impacto do Cirurgião-Dentista na Unidade de Terapia Intensiva (UTI)

Defining Clinical and Microbiological Nonresponse in Ventilator-Associated Pneumonia

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