Effect From Multiple Episodes of Inadequate Empiric Antibiotic Therapy for Ventilator-Associated Pneumonia on Morbidity and Mortality Among Critically Ill Trauma Patients

Mueller, Eric; Hanes, Scott D.; Croce, Martin A.; Wood, George C.; Boucher, Bradley A.; Fabian, Timothy C.

doi:10.1097/01.ta.0000141890.29032.9a

Cited by 65 publications

(44 citation statements)

References 26 publications

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“…The nosocomial bacteria that usually cause VAP tend to be more antibiotic resistant (306). Ramzy and colleagues (356) demonstrated that although the organisms colonizing the burn wound were similar to those recovered from quantitative culture of bronchoalveolar lavage fluid samples in pediatric burn patients with VAP, quantitative wound culture was not predictive of cross-infection in the lung.…”

Section: Pneumoniamentioning

confidence: 99%

“…Burn patients with severe inhalation injury requiring prolonged intubation are also at risk for developing ventilator-associated pneumonia (VAP) (35,86,306,378,431,445,446). VAP is defined as pneumonia that develops more than 48 h after intubation (e.g., late onset) in a mechanically ventilated patient who had no signs of this complication at the time the endotracheal tube was inserted.…”

Section: Pneumoniamentioning

confidence: 99%

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Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,595

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Section: Pneumoniamentioning

confidence: 99%

Section: Pneumoniamentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,595

1,345

View full text Add to dashboard Cite

show abstract

“…Unit-specific antibiograms also may reduce the likelihood of inappropriate prescribing of empiric therapy, which correlates with poor clinical outcomes [24]. In our S/TICU, the unit-specific antibiogram led to changes in empiric antimicrobial choices for patients with suspected HAP/VAP.…”

Section: Discussionmentioning

confidence: 94%

Antimicrobial Susceptibilities of Respiratory Pathogens in the Surgical/Trauma Intensive Care Unit Compared with the Hospital-Wide Respiratory Antibiogram in a Level I Trauma Center

Al-Dahir

Brakta

et al. 2015

Surgical Infections

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Background: Unit-specific antibiograms have developed to guide clinicians to appropriate antibiotic choices for subsets of patients. The additional level of a unit-and respiratory-specific antibiogram for surgical and trauma patients defines key differences in susceptibility information for treating hospital-acquired pneumonia.Methods: This was a three-year, retrospective single-center study. A total of 729 positive respiratory specimens from 612 patients were analyzed using Quality Compass Pathfinder

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“…In hospital-acquired pneumonia or ventilatorassociated pneumonia, inadequate empirical treatment is associated with high costs, morbidity, and mortality (2,9,17,18). In one study of adult trauma patients who experienced more than one ventilator-associated pneumonia episode for which inadequate empirical treatment was received, almost half of patients died (21). Clearly, the emergence and continued spread of antibiotic resistance require the introduction of new broad-spectrum antimicrobials that can improve outcomes, reduce the economic and medical burdens of MDR strains, and limit further development of resistance.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Efficacy of the Novel Aminoglycoside ACHN-490 in Murine Infection Models

Reyes¹,

Aggen²,

Kostrub³

2011

Antimicrob Agents Chemother

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Aminoglycosides are broad-spectrum antibiotics with particular clinical utility against life-threatening infections. As resistance to antibiotics, including aminoglycosides, continues to grow, there is a need for new and effective antimicrobial agents. ACHN-490 is a novel aminoglycoside in clinical development with activity against multidrugresistant Gram-negative and select Gram-positive pathogens. Here we assess the in vivo efficacy of ACHN-490 against a variety of common pathogens in two murine models: the septicemia and neutropenic thigh models. When its activity against a gentamicin-susceptible strain of Escherichia coli was tested in the septicemia model, ACHN-490 improved 7-day survival with a dose-response profile similar to that of gentamicin, with 100% survival seen at doses of 1.6 mg/kg of body weight and above. In animals infected with a gentamicin-susceptible strain of Pseudomonas aeruginosa, treatment with either ACHN-490 or gentamicin led to 100% survival at doses of 16 mg/kg and above in the septicemia model. ACHN-490 was also effective in the neutropenic thigh model, reducing multidrug-resistant Enterobacteriaceae family and methicillin-resistant Staphylococcus aureus strains, as well as broadly susceptible strains, to static levels with dose-dependent activity. Against gentamicin-sensitive Enterobacteriaceae and methicillinresistant S. aureus, the efficacy of ACHN-490 was comparable to that of gentamicin. However, gentamicin-resistant Enterobacteriaceae strains and those harboring the Klebsiella pneumoniae carbapenemase responded to ACHN-490 but not gentamicin, with static doses ranging from 12 mg/kg to 64 mg/kg for ACHN-490. These results suggest that ACHN-490 has the potential to become a clinically useful agent against drug-resistant pathogens, including Enterobacteriaceae, P. aeruginosa, and methicillin-resistant S. aureus, and support further development of this promising novel aminoglycoside.

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Effect From Multiple Episodes of Inadequate Empiric Antibiotic Therapy for Ventilator-Associated Pneumonia on Morbidity and Mortality Among Critically Ill Trauma Patients

Abstract: Critically ill trauma patients experiencing multiple episodes of IEAT for VAP have increased morbidity and mortality. These findings reinforce the importance of developing and refining a unit-specific pathway for the empiric management of VAP.

Cited by 65 publications

References 26 publications

Burn Wound Infections

Burn Wound Infections

Antimicrobial Susceptibilities of Respiratory Pathogens in the Surgical/Trauma Intensive Care Unit Compared with the Hospital-Wide Respiratory Antibiogram in a Level I Trauma Center

In Vivo Efficacy of the Novel Aminoglycoside ACHN-490 in Murine Infection Models

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