Antibiotic prescription for respiratory tract infections in ventilated patients: where are we heading?

Rello, Jordi; Lipman, Jeffrey

doi:10.1007/s00134-013-2983-z

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Optimization of antibiotics does not mean strictly following guidelines; instead it means empowerment, stewardship and team working. Antibiotic stewardship is a simple and cost-effective way to improve clinical outcomes while minimizing antibiotic side effects and its negative consequences; maintaining quality of care [ 33 , 34 ].…”

Section: Vap Managementmentioning

confidence: 99%

How to approach and treat VAP in ICU patients

Borgatta

Rello

2014

BMC Infect Dis

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BackgroundVentilator-associated pneumonia (VAP) is one of the most frequent clinical problems in ICU with an elevated morbidity and costs associated with it, in addition to prolonged MV, ICU-length of stay (LOS) and hospital-length of stay. Current challenges in VAP management include the absence of a diagnostic gold standard; the lack of evidence regarding contamination vs. airway colonization vs. infection; and the increasing antibiotic resistance. We performed a Pubmed search of articles addressing the management of ventilator-associated pneumonia (VAP). Immunocompromised patients, children and VAP due to multi-drug resistant pathogens were excluded from the analysis. When facing a patient with VAP, it’s important to address a few key questions for the patient’s optimal management: when should antibiotics be started?; what microorganisms should be covered?; is there risk for multirresistant microorganisms?; how to choose the initial agent?; how microbiological tests determine antibiotic changes?; and lastly, which dose and for how long?. It’s important not to delay adequate treatment, since outcomes improve when empirical treatment is early and effective. We recommend short course of broad-spectrum antibiotics, followed by de-escalation when susceptibilities are available. Individualization of treatment is the key to optimal management.

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Section: Vap Managementmentioning

confidence: 99%

How to approach and treat VAP in ICU patients

Borgatta

Rello

2014

BMC Infect Dis

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Empiric antimicrobial therapy for ventilator-associated pneumonia after brain injury

Roquilly¹,

Feuillet

Séguin

et al. 2016

Eur Respir J

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Issues regarding recommendations on empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) have emerged in specific populations.To develop and validate a score to guide empiric therapy in brain-injured patients with VAP, we prospectively followed a cohort of 379 brain-injured patients in five intensive care units. The score was externally validated in an independent cohort of 252 brain-injured patients and its extrapolation was tested in 221 burn patients.The multivariate analysis for predicting resistance (incidence 16.4%) showed two independent factors: preceding antimicrobial therapy ≥48 h (p<0.001) and VAP onset ≥10 days (p<0.001); the area under the receiver operating characteristic curve (AUC) was 0.822 (95% CI 0.770-0.883) in the learning cohort and 0.805 (95% CI 0.732-0.877) in the validation cohort. The score built from the factors selected in multivariate analysis predicted resistance with a sensitivity of 83%, a specificity of 71%, a positive predictive value of 37% and a negative predictive value of 96% in the validation cohort. The AUC of the multivariate analysis was poor in burn patients (0.671, 95% CI 0.596-0.751).Limited-spectrum empirical antimicrobial therapy has low risk of failure in brain-injured patients presenting with VAP before day 10 and when prior antimicrobial therapy lasts <48 h.

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