Microbiological lung surveillance in mechanically ventilated patients, using non-directed bronchial lavage and quantitative culture

A’Court, Christine; Garrard, C S; Crook, D; Bowler, I.C.J.W.; Conlon, Christopher P.; Peto, Tim E. A.; Anderson, Ewan M.

doi:10.1093/qjmed/86.10.635

Cited by 116 publications

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“…To facilitate the diagnosis of VAP and improve comparability between clinical trials, the CPIS is often used in clinical practice and literature [12,13,35,36,37,38,39,40]. Such a scoring system is not available for diagnosing HAP.…”

Section: Discussionmentioning

confidence: 99%

A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

et al. 2014

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Background: Pneumonia is a frequently observed complication following esophagectomy. The lack of a uniform definition of pneumonia leads to large variations of pneumonia rates in literature. This study was designed to develop a scoring system for diagnosing pneumonia following esophagectomy at the hospital ward. Methods: In a prospective cohort study of esophagectomy patients, known risk factors for pneumonia, temperature, leukocyte count, pulmonary radiography and sputum culture added were evaluated. Primary outcome was defined as the decision to treat suspected pneumonia. Multivariate Cox regression analysis with backward selection was used to identify predictors of pneumonia treatment. Results: The majority of postoperative pneumonia treatments (88.2%) occurred at the hospital ward, where treatment was observed in 67 (36.2%) of 185 patients. Independent diagnostic determinants for pneumonia treatment were temperature (hazard ratio (HR) = 1.283, p = 0.073), leukocyte count (HR = 1.040, p = 0.078) and pulmonary radiography (HR >11.0, p = 0.000). Sputum culture did not influence the decision to treat pneumonia. These findings were used to develop a scoring system which includes temperature, leukocyte count and pulmonary radiography. Conclusion: The decision to treat pneumonia is based on temperature, leukocyte count and pulmonary radiography findings. The proposed clinical scoring system for pneumonia following esophagectomy at the hospital ward has the potential to aid clinical practice and improve comparability of future research in esophageal cancer surgery.

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Section: Discussionmentioning

confidence: 99%

A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

et al. 2014

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“…The data to determine the clinical pulmonary infection score (CPIS) (Pugin et al [23], as modified by A'Court et al [24], see Table 1) was prospectively obtained daily by the chief investigator (GN) from five commonly used clinical parameters, namely body temperature, leukocyte count, volume and character of tracheal secretions, lowest PaO 2 /FiO 2 ratio, and chest radiographic changes. All physiotherapy, medical, and nursing staff involved in the study did not have knowledge of the daily CPIS score, as it was not calculated until completion of trial patient recruitment.…”

Section: Methodsmentioning

confidence: 99%

Chest physiotherapy for the prevention of ventilator-associated pneumonia

et al. 2002

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“…This could potentially be achieved by utilizing serial surveillance endotracheal aspirate cultures and initiating antibiotic therapy before the onset of symptoms. Initiation of treatment during VAT may be prudent given previous findings that showed increases in lower respiratory tract colonization over the duration of mechanical ventilation, with a peak occurring ϳ2 days before the emergence of clinical signs and symptoms of VAP (242,243). This window of microbial influx before symptoms appear could represent VAT and a viable window in which to begin therapy with antimicrobials, although this requires further research, as at least one study has shown a lack of a protective effect against subsequent VAP for antimicrobial treatment in patients with VAT (244).…”

Section: Ventilator-associated Tracheobronchitismentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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Microbiological lung surveillance in mechanically ventilated patients, using non-directed bronchial lavage and quantitative culture

Cited by 116 publications

References 0 publications

A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

A New Clinical Scoring System to Define Pneumonia following Esophagectomy for Cancer

Chest physiotherapy for the prevention of ventilator-associated pneumonia

Inhaled Antibiotics for Gram-Negative Respiratory Infections

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