Development of a Guideline for the Management of Ventilator-Associated Pneumonia Based on Local Microbiologic Findings and Impact of the Guideline on Antimicrobial Use Practices

Dellit, Timothy H.; Chan, Jeannie D.; Skerrett, Shawn J.; Nathens, Avery B.

doi:10.1086/588160

Cited by 65 publications

(52 citation statements)

References 14 publications

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“…Previous studies also found no significant reduction in mortality after the development and implementation of local treatment protocols, although these were associated with an improvement in empiric therapy adaptation and a reduction in the antibiotic treatment duration [13, 25]. …”

Section: Discussionmentioning

confidence: 99%

“…Various studies on severe infections in hospitalized patients, especially those in intensive care units (ICUs), have associated an inappropriate initial antibiotic treatment with increases in bacterial resistance, morbidity-mortality, hospital stay, and hospital costs [3–12]. Selection of the appropriate empiric antibiotic treatment requires knowledge of changes in the etiology of infectious processes and in antibiotic resistance patterns in each hospital area [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

“…The selection of empiric antibiotic therapy is generally based on updated clinical practice guidelines or therapeutic recommendations developed by expert groups from scientific societies [15–17], which must be adapted to the epidemiologic characteristics of each country or healthcare area [13, 18]. Once microbiological results are confirmed and the satisfactory clinical progression of patients is observed, it is recommended to deescalate antibiotic therapy when possible in accordance with the antibiograms of the identified bacteria [3, 6, 10, 11, 15, 19].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

Rodríguez-Maresca

Sorlózano

Grau

et al. 2014

BioMed Research International

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A prospective quasi-experimental study was undertaken in 218 patients with suspicion of nosocomial infection hospitalized in a polyvalent ICU where a new electronic device (GERB) has been designed for antibiotic prescriptions. Two GERB-based applications were developed to provide local resistance maps (LRMs) and preliminary microbiological reports with therapeutic recommendation (PMRTRs). Both applications used the data in the Laboratory Information System of the Microbiology Department to report on the optimal empiric therapeutic option, based on the most likely susceptibility profile of the microorganisms potentially responsible for infection in patients and taking into account the local epidemiology of the hospital department/unit. LRMs were used for antibiotic prescription in 20.2% of the patients and PMRTRs in 78.2%, and active antibiotics against the finally identified bacteria were prescribed in 80.0% of the former group and 82.4% of the latter. When neither LMRs nor PMRTRs were considered for empiric treatment prescription, only around 40% of the antibiotics prescribed were active. Hence, the percentage appropriateness of the empiric antibiotic treatments was significantly higher when LRM or PMRTR guidelines were followed rather than other criteria. LRMs and PMRTRs applications are dynamic, highly accessible, and readily interpreted instruments that contribute to the appropriateness of empiric antibiotic treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

Rodríguez-Maresca

Sorlózano

Grau

et al. 2014

BioMed Research International

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“…[43][44][45] A similar single-institution study evaluated a newly developed guideline on the antimicrobial use practices. 46 After the guideline was implemented, antimicrobial therapy was more frequently tailored based on quantitative culture results with a mean reduction in the duration of therapy (12.0 vs 10.7 days; P ¼ .0014).…”

Section: Ventilator-associated Pneumoniamentioning

confidence: 99%

Treatment Algorithms in Critical Care: Do They Improve Outcomes?

Nissen

Olsen

2010

Journal of Pharmacy Practice

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Patients admitted to the intensive care unit (ICU) often have significant underlying morbidities that require complex treatment plans. Because of these complexities, numerous guidelines have been developed to facilitate the management of the critically ill patient. Some of these guidelines include sepsis, community-acquired and ventilator-associated pneumonia, sedation, and glycemic control. Once guidelines are written, a treatment protocol must be developed and implemented within the critical care unit. Our medical center has implemented multiple treatment protocols, often with preprinted order sets with various degrees of success. In 2003, we implemented and later evaluated a sedation order form and protocol. Patients whose sedation was initiated with a standardized order form had more frequent sedation score assessment, less time between sedation vacations, reduced ICU length of ICU stay, and a trend in reduction of ventilator days. However, only 37% of eligible patients were treated using the order form and the protocol, despite the potentially beneficial effects. Some recommendations within guidelines are based on sound clinical evidence supported by randomized controlled trials, although others are based on expert opinion only. The most often-cited reason for protocol noncompliance is disagreement with the published clinical trial data. This paper examines both infectious and noninfectious treatment guidelines and the supportive evidence that they improved patient outcomes. In addition, strategies for successful implementation of a treatment guideline are discussed for clinicians to follow in order to maximize clinical outcomes.

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“…18 The guidelines promoted the use of quantitative bronchoscopy for diagnosis and initiated empiric therapy based on local microbiologic findings and resistance patterns. Therapy was then tailored based on culture results, and the duration of therapy was carefully considered based on clinical response.…”

Section: Use Of Institutional Guidelines In Vap Management and Prevenmentioning

confidence: 99%

Redefining Success for VAP: 360-Degree Approach

Nicolau¹,

Burgess²,

Rodvold³

2009

JMCP

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Development of a Guideline for the Management of Ventilator-Associated Pneumonia Based on Local Microbiologic Findings and Impact of the Guideline on Antimicrobial Use Practices

Cited by 65 publications

References 14 publications

Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

Treatment Algorithms in Critical Care: Do They Improve Outcomes?

Redefining Success for VAP: 360-Degree Approach

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