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VAP and antibiotic

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https://www.readbyqxmd.com/read/28100714/the-dynamics-of-the-pulmonary-microbiome-during-mechanical-ventilation-in-the-intensive-care-unit-and-the-association-with-occurrence-of-pneumonia
#1
Tetyana Zakharkina, Ignacio Martin-Loeches, Sébastien Matamoros, Pedro Povoa, Antoni Torres, Janine B Kastelijn, Jorrit J Hofstra, B de Wever, Menno de Jong, Marcus J Schultz, Peter J Sterk, Antonio Artigas, Lieuwe D J Bos
RATIONALE: Ventilator-associated pneumonia (VAP) is the most common nosocomial infections in patients admitted to the ICU. The adapted island model predicts several changes in the respiratory microbiome during intubation and mechanical ventilation. OBJECTIVES: We hypothesised that mechanical ventilation and antibiotic administration decrease the diversity of the respiratory microbiome and that these changes are more profound in patients who develop VAP. METHODS: Intubated and mechanically ventilated ICU-patients were included...
January 18, 2017: Thorax
https://www.readbyqxmd.com/read/28092204/impact-of-combination-therapy-and-early-de-escalation-on-outcome-of-ventilator-associated-pneumonia-caused-by-pseudomonas-aeruginosa
#2
Laurène Deconinck, Agnès Meybeck, Pierre Patoz, Nicolas Van Grunderbeeck, Nicolas Boussekey, Arnaud Chiche, Pierre-Yves Delannoy, Hugues Georges, Olivier Leroy
BACKGROUND: Pseudomonas aeruginosa is a common cause of ventilator-associated pneumonia (VAP). Guidelines recommend dual coverage of P. aeruginosa, but the beneficial effect of combination therapy is controversial. We described antibiotic prescriptions and evaluated the clinical impact of initial combination antibiotic therapy and de-escalation strategy in patients with VAP caused by P. aeruginosa. METHODS: Between 1994 and 2014, all 100 patients with VAP caused by P...
January 16, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28034888/ultra-short-course-antibiotics-for-patients-with-suspected-ventilator-associated-pneumonia-but-minimal-and-stable-ventilator-settings
#3
Michael Klompas, Lingling Li, John T Menchaca, Susan Gruber
PURPOSE: Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation. We compared outcomes amongst patients with suspected VAP but minimal and stable ventilator settings treated with 1-3 versus >3 days of antibiotics. METHODS: We identified consecutive adult patients started on antibiotics for possible VAP with daily minimum PEEPs ≤5cm H2O and FiO2s ≤40% for at least 3 days within a large tertiary care hospital between 2006-2014...
December 29, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27992528/colistin-dosage-without-loading-dose-is-efficacious-when-treating-carbapenem-resistant-acinetobacter-baumannii-ventilator-associated-pneumonia-caused-by-strains-with-high-susceptibility-to-colistin
#4
Rocío Álvarez-Marín, Rafael López-Rojas, Juan Antonio Márquez, María José Gómez, José Molina, José Miguel Cisneros, Carlos Ortiz-Leyba, Javier Aznar, José Garnacho-Montero, Jerónimo Pachón
OBJECTIVES: This study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV). METHODS: A prospective cohort study was performed in an ICU of adult patients (February 2010-June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6...
2016: PloS One
https://www.readbyqxmd.com/read/27916621/point-should-inhaled-antibiotic-therapy-be-routinely-used-for-the-treatment-of-bacterial-lower-respiratory-tract-infections-in-the-icu-setting-yes
#5
EDITORIAL
Richard G Wunderink
Routine use of aerosolized antibiotics is the most rational approach to the current treatment dilemmas for severe hospital-acquired pneumonia (HAP) requiring endotracheal intubation or ventilator-associated pneumonia (VAP). The two main issues for HAP/VAP are inappropriate initial therapy and ineffective therapy for multidrug resistant (MDR) pathogens, particularly gram negative bacilli such as Pseudomonas aeruginosa and Acinetobacter species. The emergence of extended spectrum beta-lactamases (ESBL) and carbapenem resistance in Enterobacteriaceae (CRE) have made even common pathogens such as Escherichia coli difficult to treat...
November 22, 2016: Chest
https://www.readbyqxmd.com/read/27911257/individualized-antibiotic-therapy-in-patients-with-ventilator-associated-pneumonia
#6
Gurdal Yilmaz, Sedat Saylan, Firdevs Aksoy, Iftihar Koksal
The optimal duration of treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1-week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10-14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital's intensive care units between 1 January and 31 December, 2015...
December 1, 2016: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/27895901/prevention-of-hospital-acquired-pneumonia-in-non-ventilated-adult-patients-a-narrative-review
#7
REVIEW
Leonor Pássaro, Stephan Harbarth, Caroline Landelle
BACKGROUND: Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP). AIM: The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. METHODS: A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations...
2016: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/27890714/a-randomized-trial-of-the-amikacin-fosfomycin-inhalation-system-for-the-adjunctive-therapy-of-gram-negative-ventilator-associated-pneumonia-iasis-trial
#8
Marin H Kollef, Jean-Damien Ricard, Damien Roux, Bruno Francois, Eleni Ischaki, Zsolt Rozgonyi, Thierry Boulain, Zsolt Ivanyi, Gál János, Denis Garot, Firas Koura, Epaminondas Zakynthinos, George Dimopoulos, Antonio Torres, Wayne Danker, A Bruce Montgomery
BACKGROUND: Clinical failures in ventilator-associated pneumonia (VAP) caused by Gram-negative bacteria are common and associated with substantial morbidity, mortality, and resource utilization. METHODS: We assessed the safety and efficacy of the amikacin fosfomycin inhalation system (AFIS) for the treatment of Gram-negative bacterial VAP in a randomized double-blind, placebo-controlled, parallel group, phase 2 study between May 2013 and March 2016. We compared standard of care in each arm plus 300 mg amikacin/120 mg fosfomycin or placebo (saline), delivered by aerosol twice daily for 10 days (or to extubation if <10 days) via the investigational eFlow Inline System (PARI GmbH, Germany)...
November 24, 2016: Chest
https://www.readbyqxmd.com/read/27850355/717-ultrashort-course-antibiotics-for-suspected-vap-with-minimal-and-stable-ventilator-settings
#9
Michael Klompas, Lingling Li, John Menchaca, Susan Gruber
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27790437/ventilator-associated-pneumonia-in-an-infant-caused-by-stenotrophomonas-maltophila-a-case-report
#10
Neelima Angaali, Nina Dutta Roy, Sudharshan Raj Chitgupikar, Preeti Subramanian, Jaya Lakshmi Pabbati
Stenotrophomonas maltophila (S.maltophila) is an aerobic Gram-negative bacillus that is a frequent colonizer of fluids used in the hospital setting. The organism is known to cause life threatening infections in immuno-compromised patients especially in those who are neutropenic, on chemotherapy or on broad spectrum antibiotics. We report a case of ventilator associated pneumonia caused by Stenotrophomonas maltophila in a two-month old infant who later developed multi organ dysfunction syndrome. In seriously ill paediatric patients, S...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27782809/clinical-and-molecular-characteristics-of-klebsiella-pneumoniae-ventilator-associated-pneumonia-in-mainland-china
#11
Si Guo, JingJing Xu, YanShuan Wei, JunHong Xu, Yi Li, Rui Xue
BACKGROUND: Klebsiella pneumoniae is a prominent nosocomial pathogen that accounts for up to 10 % of all hospital-acquired infections. It is a frequent cause of ventilator-associated pneumonia (VAP). The purpose of this study was to investigate the clinical characteristics of K. pneumoniae-associated VAP and the molecular characteristics of K. pneumoniae strains. METHODS: We retrospectively reviewed 70 mechanically ventilated patients with K. pneumoniae isolated...
October 26, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27778318/oral-hygiene-care-for-critically-ill-patients-to-prevent-ventilator-associated-pneumonia
#12
REVIEW
Fang Hua, Huixu Xie, Helen V Worthington, Susan Furness, Qi Zhang, Chunjie Li
BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs)...
October 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27771978/challenges-and-opportunities-in-the-treatment-of-ventilator-associated-pneumonia
#13
Matthew P Schreiber, Andrew F Shorr
Ventilator-associated pneumonia (VAP) is a distinct clinical entity characterized by an onset after 48 hours of the application of mechanical ventilation (MV). Protocols exist to aid in the prevention of VAP, but this infection carries a devastating impact on patient morbidity and potentially mortality. Areas covered: In this review we present key concepts from existing guidelines to aid clinicians. Challenges remain in defining this disease and, most importantly appropriate empiric antimicrobial treatment is the main determinant of outcome...
January 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27763732/antibiotics-for-ventilator-associated-pneumonia
#14
REVIEW
Lauren E Arthur, Russell S Kizor, Adrian G Selim, Mieke L van Driel, Leonardo Seoane
BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality, complicating the medical course of approximately 10% of mechanically-ventilated patients, with an estimated attributable mortality of 13%. To treat VAP empirically, the American Thoracic Society currently recommends antibiotic therapy based on the patients' risk of colonisation by an organism with multidrug resistance. The selection of initial antibiotic therapy in VAP is important, as inappropriate initial antimicrobial treatment is associated with higher mortality and longer hospital stay in intensive care unit (ICU) patients...
October 20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27729350/prevalence-of-gram-negative-bacteria-in-ventilator-associated-pneumonia-in-neonatal-intensive-care-units-a-systematic-review-and-meta-analysis-protocol
#15
Yousef Erfani, Arezoo Rasti, Leila Janani
INTRODUCTION: Ventilator-associated pneumonia (VAP) is a common and potentially lethal problem among mechanically ventilated neonates in neonatal intensive care units (NICUs). The main pathogenic bacteria of VAP in NICUs are Gram-negative pathogens, which show a general decline in sensitivities to commonly used antibiotics, but their true prevalence is not known. METHODS AND ANALYSIS: We aim to provide a systematic review of studies measuring the prevalence of Gram-negative bacteria in VAP in NICUs...
October 11, 2016: BMJ Open
https://www.readbyqxmd.com/read/27714594/rapid-diagnostic-test-and-use-of-antibiotic-against-methicillin-resistant-staphylococcus-aureus-in-adult-intensive-care-unit
#16
A-F Dureau, G Duclos, F Antonini, D Boumaza, N Cassir, J Alingrin, C Vigne, E Hammad, L Zieleskiewicz, M Leone
Ventilator-associated pneumonia (VAP) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with excess mortality and costs. Molecular biology test allows rapid identification of MRSA in sputum with high negative predictive value. We hypothesized that use of a rapid diagnostic test in patients with suspected VAP was associated with reduced use of antibiotics directed against MRSA. This retrospective, observational study was conducted in a polyvalent intensive care unit (ICU) of a university hospital...
February 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/27680980/pre-emptive-antibiotic-therapy-to-reduce-ventilator-associated-pneumonia-thinking-outside-the-box
#17
Donald E Craven, Jana Hudcova, Yuxiu Lei, Kathleen A Craven, Ahsan Waqas
Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a meta-analysis have reported antibiotic treatment for VAT can reduce VAP, ventilator days, length of intensive care unit (ICU) stay, and patient morbidity and mortality...
September 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27642332/annual-antibiotic-related-economic-burden-of-healthcare-associated-infections-a-cross-sectional-population-based-study
#18
Maryam Karkhane, Mohamad Amin Pourhosiengholi, Mohammad Reza Akbariyan Torkabad, Zahra Kimiia, Seyed Mehdi Mortazavi, Seyed Karim Hossieni Aghdam, Abdolrazagh Marzban, Mohammad Reza Zali
So far, too little attention has been paid to total burden of healthcare associated infections (HAIs) in Iran. In the present study, we aimed to assess the rate of HAIs, as well as economic burden of hospitalization and antibiotic related cost associated with HAIs in ICU at training Taleghani hospital in Iran and to compare our results with national nosocomial infections surveillance (NNIS) system. This research to date for the first time has tended to focus on the economic burden of HAIs rather than epidemiology of HAIs evaluation...
2016: Iranian Journal of Pharmaceutical Research: IJPR
https://www.readbyqxmd.com/read/27588017/is-helics-the-right-way-lack-of-chest-radiography-limits-ventilator-associated-pneumonia-surveillance-in-wales
#19
Richard Pugh, Wendy Harrison, Susan Harris, Hywel Roberts, Gareth Scholey, Tamas Szakmany
INTRODUCTION: The reported incidence of ventilator-associated pneumonia (VAP) in Wales is low compared with surveillance data from other European regions. It is unclear whether this reflects success of the Welsh healthcare-associated infection prevention measures or limitations in the application of European VAP surveillance methods. Our primary aim was to investigate episodes of ventilator-associated respiratory tract infection (VARTI), to identify episodes that met established criteria for VAP, and to explore reasons why others did not, according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions...
2016: Frontiers in Microbiology
https://www.readbyqxmd.com/read/27542315/clinical-epidemiology-treatment-and-prognostic-factors-of-extensively-drug-resistant-acinetobacter-baumannii-ventilator-associated-pneumonia-in-critically-ill-patients
#20
Constantinos Tsioutis, Evangelos I Kritsotakis, Spyridon A Karageorgos, Soultana Stratakou, Charalambos Psarologakis, Sofia Kokkini, Achilleas Gikas
Limited data exist regarding prognostic factors and optimal antimicrobial treatment of infections caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB). This retrospective cohort study included 93 adult patients who developed ventilator-associated pneumonia (VAP) due to XDR-AB in the ICU of the University Hospital of Heraklion, Greece, from October 2012 to April 2015. XDR-AB isolates were mainly susceptible to colistin (93.5%) and tigecycline (25.8%), whereas 6 (6.5%) were pandrug-resistant...
November 2016: International Journal of Antimicrobial Agents
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