Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU

Ekren, Pervin Korkmaz; Ranzani, Otávio T.; Ceccato, Adrián; Bassi, Gianluigi Li; Conejero, Eva Muñoz; Ferrer, Miquel; Niederman, Michael S.; Torres, Antoni

doi:10.1164/rccm.201708-1717le

Cited by 47 publications

(31 citation statements)

References 10 publications

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“…In addition, being aware that hospital pneumonia cases are usually caused by MDR Gram-negative bacteria [ 31 ], the potency of TTO was also evaluated in the VP [ 32 ]. Even though the VP efficacy was globally lower than that observed with the disk diffusion analysis (liquid phase), antibacterial activity was retained against E. coli and both CS and CR-Kp whereas no activity was found with regard to MSSA, MRSA, and CR-Pa. Interestingly, TTO in VP maintained an elevated activity towards CR-Ab, thus corroborating the results obtained by Miao Li et al in their model of pulmonary delivery of tea tree oil-b-cyclodextrin inclusion complexes [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

High Potency of Melaleuca alternifolia Essential Oil against Multi-Drug Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus aureus

Oliva

Costantini

et al. 2018

Molecules

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Purpose: Herein, an extended investigation of Tea tree oil (TTO) against a number of multi-drug resistant (MDR) microorganisms in liquid and vapor phases is reported. Methods: The activity of TTO was tested against methicillin-sensitive Staphylococcus aureus (MSSA), Escherichia coli, and clinical strains of methicillin-resistant S. aureus (MRSA), extended-spectrum beta lactamases producer carbapenem-sensitive Klebsiella pneumoniae (ESBL-CS-Kp), carbapenem-resistant K. pneumoniae (CR-Kp), Acinetobacter baumannii (CR-Ab), and Pseudomonas aeruginosa (CR-Pa). Minimal inhibitory/bactericidal concentrations (MIC/MBCs) and synergistic activity between TTO and different antimicrobials were determined. In the vapor assay (VP), TTO-impregnated discs were placed on the lid of a petri dish and incubated for 24 h at 37 °C. Results: TTO showed a potent bactericidal activity against all the tested microorganisms. TTO in combination with each reference antimicrobial showed a high level of synergism at sub-inhibitory concentrations, particularly with oxacillin (OXA) against MRSA. The VP assay showed high activity of TTO against CR-Ab. Conclusion: Evaluation of in-vitro activity clearly indicated TTO as a potential effective antimicrobial treatment either alone or in association with known drugs against MDR. Therefore, TTO could represent the basis for a possible role in non-conventional regimens against S. aureus and Gram-negative MDR. TTO in VP might represent a promising option for local therapy of pneumonia caused by CR-Ab.

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Section: Discussionmentioning

confidence: 99%

High Potency of Melaleuca alternifolia Essential Oil against Multi-Drug Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus aureus

Oliva

Costantini

et al. 2018

Molecules

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“…[34%] patients, reflecting the poor performance of all risk factors when taken individually for avoiding overuse of broad-spectrum antibiotics in this setting, with always higher-sensitivity values compared with specificity [39]. The highest negative predictive values were for intravenous antibiotic use (79%) and 5 or more days of hospitalization before pneumonia (80%).…”

Section: Microbial Etiologies Of Vapmentioning

confidence: 99%

Microbial cause of ICU-acquired pneumonia: hospital-acquired pneumonia versus ventilator-associated pneumonia

Luyt

Hékimian

Koulenti

et al. 2018

Current Opinion in Critical Care

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“…[3][4][5] Unfortunately, clinical risk factors for MRSA pneumonia do not reliably discriminate between MRSA and other bacterial causes of pneumonia. [6][7][8][9] Although the incidence of culture-positive MRSA pneumonia has clearly not increased and may even have decreased in recent years, [10][11][12] empiric use of antibiotics specifically for suspected MRSA pneumonia has increased substantially since the introduction of the ATS/IDSA guidelines in 2005. 10,[13][14][15][16] Indiscriminate use of broadspectrum antibiotics accelerates the problem of increasing antibiotic resistance, in addition to unnecessarily exposing patients to associated adverse side effects of these drugs.…”

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confidence: 99%

Rapid Detection of Methicillin-Resistant Staphylococcus aureus in BAL

Paonessa

Shah

Pickens

et al. 2019

Chest

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BACKGROUND: Guidelines recommend empirical vancomycin or linezolid for patients with suspected pneumonia at risk for methicillin-resistant Staphylococcus aureus (MRSA). Unneeded vancomycin or linezolid use may unnecessarily alter host flora and expose patients to toxicity. We therefore sought to determine if rapid testing for MRSA in BAL can safely decrease use of vancomycin or linezolid for suspected MRSA pneumonia. METHODS: Operating characteristics of the assay were initially validated against culture on residual BAL. A prospective, unblinded, randomized clinical trial to assess the effect of antibiotic management made on the basis of rapid diagnostic testing (RDT) compared with usual care was subsequently conducted, with primary outcome of duration of vancomycin or linezolid administration. Secondary end points focused on safety. RESULTS: Sensitivity of RPCR was 95.7%, with a negative likelihood ratio of 0.04 for MRSA. The clinical trial randomized 45 patients: 22 to antibiotic management made on the basis of RDT and 23 to usual care. Duration of vancomycin or linezolid administration was significantly reduced in the intervention group (32 h [interquartile range, 22-48] vs 72 h [interquartile range, 50-113], P < .001). Proportions with complications and length of stay trended lower in the intervention group. Hospital mortality was 13.6% in the intervention group and 39.1% for usual care (95% CI of difference,-3.3 to 50.3, P ¼ .06). Standardized mortality ratio was 0.48 for the intervention group and 1.18 for usual care. CONCLUSIONS: A highly sensitive BAL RDT for MRSA significantly reduced use of vancomycin and linezolid in ventilated patients with suspected pneumonia. Management made on the basis of RDT had no adverse effects, with a trend to lower hospital mortality.

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Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU

Cited by 47 publications

References 10 publications

High Potency of Melaleuca alternifolia Essential Oil against Multi-Drug Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus aureus

High Potency of Melaleuca alternifolia Essential Oil against Multi-Drug Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus aureus

Microbial cause of ICU-acquired pneumonia: hospital-acquired pneumonia versus ventilator-associated pneumonia

Rapid Detection of Methicillin-Resistant Staphylococcus aureus in BAL

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