Hospital‐Acquired Pneumonia, Health Care–Associated Pneumonia, Ventilator‐Associated Pneumonia, and Ventilator‐Associated Tracheobronchitis: Definitions and Challenges in Trial Design

2010 ◽  
Vol 51 (S1) ◽  
pp. S12-S17 ◽  
Author(s):  
Michael S. Niederman
Keyword(s):  
Health Care ◽  
Trial Design ◽  
Ventilator Associated Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Health Care Associated Pneumonia ◽  
Hospital Acquired

scholarly journals Management of Health-Care Associated Pneumonia (HCAP)

2013 ◽  
pp. 87-90
Author(s):  
Alessia Rosato ◽  
Claudio Santini
Keyword(s):  
Health Care ◽  
Treatment Approach ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Community Acquired Pneumonia ◽  
Traditional Classification ◽  
Hospital Acquired Pneumonia ◽  
Health Care Associated Pneumonia ◽  
Hospital Acquired

Introduction The traditional classification of Pneumonia as either community acquired (CAP) or hospital acquired (HAP) reflects deep differences in the etiology, pathogenesis, approach and prognosis between the two entities. Health-Care Associated Pneumonia (HCAP) develops in a heterogeneous group of patients receiving invasive medical care or surgical procedures in an outpatient setting. For epidemiology and outcomes, HCAP closely resembles HAP and possibly requires an analogous therapeutic regimen effective against multidrug-resistant pathogens. Materials and methods We reviewed the pertinent literature and the guidelines for the diagnosis and management of HCAP to analyze the evidence for the recommended approach. Results Growing evidence seems to confirm the differences in epidemiology and outcome between HCAP and CAP but fails to confirm any real advantage in pursuing an aggressive treatment for all HCAP and CAP patients. Discussion Further investigations are needed to establish the optimal treatment approach according to the different categories of patients and the different illness severities. Keywords Health Care Associated Pneumonia (HCAP); Community Acquired Pneumonia (CAP); Hospital Acquired Pneumonia (HAP); Multidrug-resistant (MDR) Pathogens

Pulmonary and Mycobacterial Infections

2016 ◽  
pp. 505-520
Author(s):  
Pritish K. Tosh ◽  
Elie F. Berbari
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Bacterial Infections ◽  
Mortality Rates ◽  
High Morbidity ◽  
Therapeutic Approaches ◽  
Mycobacterial Infections ◽  
Hospital Acquired Pneumonia ◽  
Health Care Associated Pneumonia ◽  
Hospital Acquired

Hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care–associated pneumonia (HCAP) cause 25% of all infections in the intensive care unit and are the basis for 50% of all antimicrobials prescribed in the hospital. These are primarily bacterial infections and are associated with high morbidity and mortality rates. However, pneumonias occurring before the fifth day of hospitalization are generally caused by organisms that are more susceptible to antimicrobials and have a better prognosis than those occurring on or after the fifth hospital day. The diagnostic and therapeutic approaches to HAP, VAP, and HCAP are similar.

scholarly journals In Vitro Activity of Doripenem, a Carbapenem for the Treatment of Challenging Infections Caused by Gram-Negative Bacteria, against Recent Clinical Isolates from the United States

2008 ◽  
Vol 52 (12) ◽  
pp. 4388-4399 ◽  
Author(s):  
Chris M. Pillar ◽  
Mohana K. Torres ◽  
Nina P. Brown ◽  
Dineshchandra Shah ◽  
Daniel F. Sahm
Keyword(s):  
The United States ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Pneumonia ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Gram Positive Cocci

ABSTRACT Doripenem, a 1β-methylcarbapenem, is a broad-spectrum antibiotic approved for the treatment of complicated urinary tract and complicated intra-abdominal infections. An indication for hospital-acquired pneumonia including ventilator-associated pneumonia is pending. The current study examined the activity of doripenem against recent clinical isolates for the purposes of its ongoing clinical development and future longitudinal analysis. Doripenem and comparators were tested against 12,581 U.S. clinical isolates collected between 2005 and 2006 including isolates of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. MICs (μg/ml) were established by broth microdilution. By MIC90, doripenem was comparable to imipenem and meropenem in activity against S. aureus (methicillin susceptible, 0.06; resistant, 8) and S. pneumoniae (penicillin susceptible, ≤0.015; resistant, 1). Against ceftazidime-susceptible Enterobacteriaceae, the MIC90 of doripenem (0.12) was comparable to that of meropenem (0.12) and superior to that of imipenem (2), though susceptibility of isolates exceeded 99% for all evaluated carbapenems. The activity of doripenem was not notably altered against ceftazidime-nonsusceptible or extended-spectrum β-lactamase screen-positive Enterobacteriaceae. Doripenem was the most potent carbapenem tested against P. aeruginosa (MIC90/% susceptibility [%S]: ceftazidime susceptible = 2/92%S, nonsusceptible = 16/61%S; imipenem susceptible = 1/98.5%S, nonsusceptible = 8/56%S). Against imipenem-susceptible Acinetobacter spp., doripenem (MIC90 = 2, 89.1%S) was twice as active by MIC90 as were imipenem and meropenem. Overall, doripenem potency was comparable to those of meropenem and imipenem against gram-positive cocci and doripenem was equal or superior in activity to meropenem and imipenem against Enterobacteriaceae, including β-lactam-nonsusceptible isolates. Doripenem was the most active carbapenem tested against P. aeruginosa regardless of β-lactam resistance.

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