Less Is More? Antibiotic Treatment Duration in<i>Pseudomonas aeruginosa</i>Ventilator-Associated Pneumonia

Albin, Owen; Kaye, Keith S.; McCreary, Erin K; Pogue, Jason M.

doi:10.1093/cid/ciac784

Cited by 18 publications

(7 citation statements)

References 10 publications

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“…This randomized, open-label, multicentre trial was stopped after 2 years because of lack of recruitment, was therefore underpowered, and failed to demonstrate the non-inferiority of the 8-day treatment on a composite endpoint that combined mortality and recurrence of lung infection [ 149 ]. Following these results, some advocated for a 14-day course of antimicrobial treatment for NF-GNB VAP [ 150 ], whereas others advocated for an 8-day course of antibiotics, arguing that besides differential time at risk bias in the iDiapason and PneumA trials [ 146 , 149 ], patients with short duration of treatment have similar outcomes and less antibiotics exposure [ 151 ]. From our point of view, duration of treatment of VAP should be set at 7 days, whatever the pathogen responsible for infections, since harms of long course of antibiotics probably overweigh its disputable benefits on relapse.…”

Section: Could We Reduce (Even More) the Duration Of Antibiotic Treat...mentioning

confidence: 99%

Antibiotic stewardship in the ICU: time to shift into overdrive

Mokrani

Chommeloux

Chambrun

et al. 2023

Ann. Intensive Care

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Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) are places where antibiotics are widely prescribed, and where multidrug-resistant pathogens are frequently encountered. However, ICU physicians may have opportunities to decrease antibiotics consumption and to apply antimicrobial stewardship programs. The main measures that may be implemented include refraining from immediate prescription of antibiotics when infection is suspected (except in patients with shock, where immediate administration of antibiotics is essential); limiting empiric broad-spectrum antibiotics (including anti-MRSA antibiotics) in patients without risk factors for multidrug-resistant pathogens; switching to monotherapy instead of combination therapy and narrowing spectrum when culture and susceptibility tests results are available; limiting the use of carbapenems to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and new beta-lactams to difficult-to-treat pathogen (when these news beta-lactams are the only available option); and shortening the duration of antimicrobial treatment, the use of procalcitonin being one tool to attain this goal. Antimicrobial stewardship programs should combine these measures rather than applying a single one. ICUs and ICU physicians should be at the frontline for developing antimicrobial stewardship programs.

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Section: Could We Reduce (Even More) the Duration Of Antibiotic Treat...mentioning

confidence: 99%

Antibiotic stewardship in the ICU: time to shift into overdrive

Mokrani

Chommeloux

Chambrun

et al. 2023

Ann. Intensive Care

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“…For instance, Pseudomonas aeruginosa (P. aeruginosa), an important opportunistic pathogen, is the main cause of ventilator-associated pneumonia, urinary tract, blood flow and chronic infection [ 734 – 736 ]. However, P. aeruginosa show natural resistance to many classes of antibiotics [ 737 ]. Not only that, the effectiveness of antimicrobials in treating P. aeruginosa infection has gradually declined in recent years [ 738 , 739 ].…”

Section: Ferroptosis In Pathologiesmentioning

confidence: 99%

The mechanism of ferroptosis and its related diseases

Feng,

Tang,

Wang

et al. 2023

Mol Biomed

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Ferroptosis, a regulated form of cellular death characterized by the iron-mediated accumulation of lipid peroxides, provides a novel avenue for delving into the intersection of cellular metabolism, oxidative stress, and disease pathology. We have witnessed a mounting fascination with ferroptosis, attributed to its pivotal roles across diverse physiological and pathological conditions including developmental processes, metabolic dynamics, oncogenic pathways, neurodegenerative cascades, and traumatic tissue injuries. By unraveling the intricate underpinnings of the molecular machinery, pivotal contributors, intricate signaling conduits, and regulatory networks governing ferroptosis, researchers aim to bridge the gap between the intricacies of this unique mode of cellular death and its multifaceted implications for health and disease. In light of the rapidly advancing landscape of ferroptosis research, we present a comprehensive review aiming at the extensive implications of ferroptosis in the origins and progress of human diseases. This review concludes with a careful analysis of potential treatment approaches carefully designed to either inhibit or promote ferroptosis. Additionally, we have succinctly summarized the potential therapeutic targets and compounds that hold promise in targeting ferroptosis within various diseases. This pivotal facet underscores the burgeoning possibilities for manipulating ferroptosis as a therapeutic strategy. In summary, this review enriched the insights of both investigators and practitioners, while fostering an elevated comprehension of ferroptosis and its latent translational utilities. By revealing the basic processes and investigating treatment possibilities, this review provides a crucial resource for scientists and medical practitioners, aiding in a deep understanding of ferroptosis and its effects in various disease situations.

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“…Regarding ventilatorassociated pneumonia (VAP), especially by Pseudomonas aeruginosa, considerable ambiguity remains in terms of risk of recurrence of infection in case of short therapy due to evidence limitations. An Individualized duration of therapy, considering prolongation of treatment durations over the first week for patients with a delayed or unfavorable clinical response to treatment seems a reasonable approach, based on available evidence [61,62].…”

Section: Statements and Rationalesmentioning

confidence: 99%

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Cortegiani

Antonelli

Falcone

et al. 2023

J Anesth Analg Crit Care

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Background Antimicrobial resistance represents a major critical issue for the management of the critically ill patients hospitalized in the intensive care unit (ICU), since infections by multidrug-resistant bacteria are characterized by high morbidity and mortality, high rates of treatment failure, and increased healthcare costs worldwide. It is also well known that antimicrobial resistance can emerge as a result of inadequate antimicrobial therapy, in terms of drug selection and/or treatment duration. The application of antimicrobial stewardship principles in ICUs improves the quality of antimicrobial therapy management. However, it needs specific considerations related to the critical setting. Methods The aim of this consensus document gathering a multidisciplinary panel of experts was to discuss principles of antimicrobial stewardship in ICU and to produce statements that facilitate their clinical application and optimize their effectiveness. The methodology used was a modified nominal group discussion. Conclusion The final set of statements underlined the importance of the specific interpretation of antimicrobial stewardship’s principles in critically ill patient management, quasi-targeted therapy, the use of rapid diagnostic methods, the personalization of antimicrobial therapies’ duration, obtaining microbiological surveillance data, the use of PK/PD targets, and the use of specific indicators in antimicrobial stewardship programs.

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Less Is More? Antibiotic Treatment Duration inPseudomonas aeruginosaVentilator-Associated Pneumonia

Cited by 18 publications

References 10 publications

Antibiotic stewardship in the ICU: time to shift into overdrive

Antibiotic stewardship in the ICU: time to shift into overdrive

The mechanism of ferroptosis and its related diseases

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

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