scholarly journals The Use of Guidelines for the Empiric Treatment of Hospital-Acquired Pneumonia

2001 ◽  
Vol 8 (4) ◽  
pp. 255-260 ◽  
Author(s):  
Michael S Miletin ◽  
Charles K Chan
Keyword(s):  
Empirical Therapy ◽  
Treated Group ◽  
Antimicrobial Treatment ◽  
University Teaching ◽  
Health Network ◽  
Hospital Acquired Pneumonia ◽  
The University ◽  
Hospital Acquired ◽  
To Receive ◽  
Microbiological Data

BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital-acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown.OBJECTIVE: To assess physicians' use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, Ontario.DESIGN: A retrospective assembly and chart review.SETTING: A university teaching hospital.PATIENTS: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10-month period.RESULTS: The charts of 115 patients were reviewed. Seventy-five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. Patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty-seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline-concordant antimicrobial therapy had no measurable effect on in-hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). Patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49).CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.

Microbiology of Ventilator–Associated Pneumonia Compared With That of Hospital-Acquired Pneumonia

2007 ◽  
Vol 28 (7) ◽  
pp. 825-831 ◽  
Author(s):  
David J. Weber ◽  
William A. Rutala ◽  
Emily E. Sickbert-Bennett ◽  
Gregory P. Samsa ◽  
Vickie Brown ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Empirical Therapy ◽  
Ventilator Associated Pneumonia ◽  
Gram Positive ◽  
Similar Frequency ◽  
Gram Negative ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Gram Positive Cocci ◽  
Ventilated Patients

Objective.Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in non-ventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.Design.Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.Setting.A tertiary care academic hospital.Patients.All patients admitted from 2000 through 2003.Results.A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 Patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% {Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).Conclusions.Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

scholarly journals Methicillin-ResistantStaphylococcus aureusin a Canadian Intensive Care Unit: Delays in Initiating Effective Therapy Due to the Low Prevalence of Infection

2007 ◽  
Vol 18 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Wendy Sligl ◽  
Geoffrey Taylor ◽  
RT Noel Gibney ◽  
Robert Rennie ◽  
Linda Chui
Keyword(s):  
Intensive Care ◽  
Cohort Analysis ◽  
Antimicrobial Treatment ◽  
Cost Of Care ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
General Systems ◽  
Mrsa Infection ◽  
The University ◽  
Hospital Acquired

INTRODUCTION: Methicillin-resistantStaphylococcus aureus(MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta.METHODS: A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005.RESULTS: Forty-six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in-hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed-field gel electrophoresis. Hospital-acquired strains were predominantly CMRSA-2 (59%), indicating that this clone circulates at the University of Alberta Hospital.CONCLUSIONS: MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community-acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital-acquired strains were CMRSA-2.

scholarly journals Hospital-acquired pneumonia: microbiological data and potential adequacy of antimicrobial regimens

2002 ◽  
Vol 20 (2) ◽  
pp. 432-439 ◽  
Author(s):  
O. Leroy ◽  
P. Giradie ◽  
Y. Yazdanpanah ◽  
H. Georges ◽  
S. Alfandari ◽  
...  
Keyword(s):  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Microbiological Data

scholarly journals Ceftobiprole Perspective: Current and Potential Future Indications

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 170 ◽  
Author(s):  
Tommaso Lupia ◽  
Carlo Pallotto ◽  
Silvia Corcione ◽  
Lucio Boglione ◽  
Francesco Giuseppe De Rosa
Keyword(s):  
Bacterial Infections ◽  
Life Experiences ◽  
Real Life ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Clinical Situation ◽  
Community Acquired Pneumonia ◽  
Severe Infections ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Ceftobiprole combines an excellent spectrum for community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) pathogens, with a low/medium MDR risk, and the β-lactams’ safety in frail patients admitted to the hospital in internal medicine wards which may be at high risk of adverse events by anti-MRSA coverage as oxazolidinones or glycopeptides. We aimed to report the available evidence regarding ceftobiprole use in pneumonia and invasive bacterial infections, shedding light on ceftobiprole stewardship. The clinical application and real-life experiences of using ceftobiprole for bloodstream infections, including infective endocarditis, are limited but nevertheless promising. In addition, extended-spectrum ceftobiprole activity, including Enterococcus faecalis, Enterobacteriaceae, and Pseudomonas aeruginosa, has theoretical advantages for use as empirical therapy in bacteremia potentially caused by a broad spectrum of microorganisms, such as catheter-related bacteremia. In the future, the desirable approach to sepsis and severe infections will be administered to patients according to their clinical situation, the intrinsic host characteristics, the susceptibility profile, and local epidemiology, while the “universal antibiotic strategy” will no longer be adequate.

scholarly journals Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Philippe Guerci ◽  
◽  
Hugo Bellut ◽  
Mokhtar Mokhtari ◽  
Julie Gaudefroy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Primary Endpoint ◽  
Antimicrobial Therapy ◽  
Stenotrophomonas Maltophilia ◽  
Antimicrobial Treatment ◽  
Hospital Death ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy. Methods This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy. Results Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively). Conclusions S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival. Trial registration clinicaltrials.gov, NCT03506191

scholarly journals Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia

2015 ◽  
Vol 53 (200) ◽  
pp. 240-243
Author(s):  
Santosh Dahal ◽  
Basista Prasad Rijal ◽  
Karbir Nath Yogi ◽  
Jeevan Bahadur Sherchand ◽  
Keshab Parajuli ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Early Onset ◽  
Late Onset ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Empirical Antibiotic Therapy ◽  
Hospital Acquired Pneumonia ◽  
Empirical Antibiotics ◽  
Microsoft Office ◽  
Hospital Acquired

Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases. Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007. Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases. Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends. Keywords: empirical therapy; hospital acquired pneumonia.

scholarly journals Hospital-Acquired Pneumonia: The Lebanese Societies for Pulmonary, Critical Care, and Infectious Diseases and Clinical Microbiology Joint Guidelines

2021 ◽  
Author(s):  
Moussa Riachy ◽  
Aline El Zakhem ◽  
Claude Afif ◽  
Jacques Choucair ◽  
Patricia Yazbeck ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Critical Care ◽  
Infectious Diseases ◽  
Patient Outcomes ◽  
Clinical Microbiology ◽  
Antimicrobial Agents ◽  
Stewardship Program ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Microbiological Data

Abstract Background: The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM), the Lebanese Society of Critical Care Medicine (LSCCM), and the Lebanese Pulmonary Society (LPS) play a major role in guiding clinicians across Lebanon in prescribing antibiotics for the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Members of these societies have tailored the international recommendations for the management of HAP/VAP to local epidemiological and microbiological data. The aims of these local guidelines are to guide clinicians in the prevention of VAP, selection of appropriate empiric and targeted antimicrobial regimens for VAP/HAP and to contribute to improving patient outcomes. Methods: Recommendations in these guidelines are adapted from international guidelines and are modeled based on locally-derived epidemiological and microbiological data, as well as the availability of antimicrobial agents and other resources. Results: These guidelines aim to combine both clinical and bacteriological strategies to appropriately diagnose and manage HAP/VAP. They recommend implementing evidence-based preventive measures to lower the rate of VAP and improve patient outcomes. The recommended duration of treatment with antibiotics in general should not exceed 7 days in patients with HAP whereas it should be 7–8 days in patients with VAP. Imunnosuppressed patients with Pseudomonas aeruginosa infection might require longer courses. Ceftolozane/tazobactam (CFT/TAZ) and ceftazidime/avibactam (CAZ/AVI) are considered good options in patients with HAP/VAP caused by extended spectrum beta-lactamase-producing Enterobacterales and multidrug-resistant Pseudomonas aeruginosa. They also play a key role in the implementation of a carbapenem-sparing strategy in an antimicrobial stewardship program. Conclusion: These guidelines represent a major step towards establishing Lebanese national guidelines for the management of HAP/VAP. They also emphasize on timeliness and appropriateness of antibiotic therapy for the management of HAP/VAP.

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