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VAP and antibiotic

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
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
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...
October 7, 2016: European Journal of Clinical Microbiology & Infectious Diseases
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
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
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
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...
August 12, 2016: International Journal of Antimicrobial Agents
Tracy Chin, Barry Kushner, Deonne Dersch-Mills, Danny J Zuege
This retrospective cohort study describes the patterns of antibiotic use for the treatment of ventilator-associated pneumonia (VAP) in the Calgary Zone of Alberta Health Services. Timing, appropriateness, and duration of antibiotics were evaluated in two hundred consecutive cases of VAP derived from 4 adult intensive care units (ICU). Antibiotic therapy was initiated in less than 24 hours from VAP diagnosis in 83% of cases. Although most patients (89%) received empiric therapy that demonstrated in vitro sensitivity to the identified pathogens, only 24% of cases were congruent with the 2008 Association of Medical Microbiology and Infectious Disease (AMMI) guidelines...
2016: Canadian Journal of Infectious Diseases & Medical Microbiology
Ana Carolina Souza-Oliveira, Thúlio Marquez Cunha, Liliane Barbosa da Silva Passos, Gustavo Camargo Lopes, Fabiola Alves Gomes, Denise Von Dolinger de Brito Röder
UNLABELLED: Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14-70%). AIM: This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. METHODS: This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia...
September 2016: Brazilian Journal of Infectious Diseases
Thomas P Hellyer, Niall H Anderson, Jennie Parker, Paul Dark, Tina Van Den Broeck, Suveer Singh, Ronan McMullan, Ashley M Agus, Lydia M Emerson, Bronagh Blackwood, Savita Gossain, Tim S Walsh, Gavin D Perkins, Andrew Conway Morris, Daniel F McAuley, A John Simpson
BACKGROUND: Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. METHODS/DESIGN: This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management...
2016: Trials
Marc Clavel, Olivier Barraud, Virginie Moucadel, Faustine Meynier, Elias Karam, Marie-Cécile Ploy, Bruno François
OBJECTIVES: Ventilator-associated pneumonia (VAP) is the most common infection in critically ill patients. Initial antibiotic therapy is often broad spectrum which promotes antibiotic resistance. New techniques are thus experimented to obtain early microbiological identification and quantification. This trial aimed at comparing the performance of a new real-time quantitative molecular-based method with conventional culture in patients with a VAP suspicion. METHODS: Patients with suspected VAP and ventilated for at least 48 hours were eligible...
July 9, 2016: Clinical Microbiology and Infection
Ali Ismail, Abdul-Karim El-Hage-Sleiman, Marianne Majdalani, Rima Hanna-Wakim, Souha Kanj, Rana Sharara-Chami
INTRODUCTION: Device-associated healthcare-associated infections (DA-HAIs) are the principal threat to patient safety in intensive care units (ICUs).  The primary objective of this study was to identify the most common DA-HAIs in the pediatric intensive care unit (PICU) at the American University of Beirut Medical Center (AUBMC). Length of stay (LOS) and mortality, antimicrobial resistance patterns, and suitability of empiric antibiotic choices for DA-HAIs according to the local resistance patterns were also studied...
2016: Journal of Infection in Developing Countries
Adamantia Liapikou, Antoni Torres
INTRODUCTION: Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections worldwide and is associated with an elevated morbidity and mortality and increased hospital costs. Nevertheless, prompt and adequate antimicrobial treatment is mandatory following VAP development, especially in the face of multidrug resistant pathogens. AREAS COVERED: We searched Pubmed and site reports in English language of phase III clinical trials, between 2000-2016 referring to the antibiotic treatment of nosocomial pneumonia...
September 2016: Expert Opinion on Emerging Drugs
Cristina Cigana, Francesca Bernardini, Marcella Facchini, Beatriz Alcalá-Franco, Camilla Riva, Ida De Fino, Alice Rossi, Serena Ranucci, Pauline Misson, Eric Chevalier, Maj Brodmann, Michel Schmitt, Achim Wach, Glenn E Dale, Daniel Obrecht, Alessandra Bragonzi
The clinical development of antibiotics with a new mode of action combined with efficient pulmonary drug delivery is a priority against untreatable Pseudomonas aeruginosa lung infections. POL7001 is a macrocycle antibiotic belonging to the novel class of protein epitope mimetic (PEM) molecules with selective and potent activity against P. aeruginosa We investigated ventilator-associated pneumonia (VAP) and cystic fibrosis (CF) as indications of the clinical potential of POL7001 to treat P. aeruginosa pulmonary infections...
August 2016: Antimicrobial Agents and Chemotherapy
Jianping Gao, Yingchang Zou, Yonggang Wang, Feng Wang, Lang Lang, Ping Wang, Yong Zhou, Kejing Ying
A number of multiresistant pathogens including Acinetobacter baumannii (A. baumannii) place a heavy burden on ventilator-associated pneumonia (VAP) patients in intensive care units (ICU). It is critically important to differentiate between bacterial infection and colonization to avoid prescribing unnecessary antibiotics. Quantitative culture of lower respiratory tract (LRT) specimens, however, requires invasive procedures. Nowadays, volatile organic compounds (VOCs) have been studied in vitro and in vivo to identify pathogen-derived biomarkers...
June 2016: Journal of Breath Research
Paula Ramirez, Cristina Lopez-Ferraz, Monica Gordon, Alexandra Gimeno, Esther Villarreal, Jesús Ruiz, Rosario Menendez, Antoni Torres
BACKGROUND: Ventilator-associated pneumonia (VAP) can have a clear onset or may be a result of the gradual appearance of symptoms and signs of VAP (gradual VAP). The aim of this paper is to describe the VAP development process with the intention of discriminating between those pneumonias with a clear beginning and those that are diagnosed after a period of maturation. In addition, we evaluate the effect of the starting time of antibiotic treatment in both situations. METHODS: Consecutive ventilated patients fulfilling VAP criteria were included...
2016: Critical Care: the Official Journal of the Critical Care Forum
Juan Wang, De-Xian Li, Chao-Xian Yu, Su Huang, Yan-Qiong Liang
OBJECTIVE: To explore the risk factors of ventilator-associated pneumonia (VAP) in patients admitted in an intensive care unit (ICU) for pulmonary tuberculosis (TB). METHODS: The clinical data of 143 patients admitted in the ICU at our center between January, 2014 and June, 2015 were reviewed. The patients with VAP and those without VAP were analyzed for risk factors of VAP in the setting of an ICU for pulmonary TB and compared for the duration of ventilation and hospital stay...
May 2016: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Aya Gozlan-Talmor, Adi Guetta, Moti Klein, Roi Westreich, Or Kalchiem Dekel, Nimrod Maimon
BACKGROUND: Ventilator associated pneumonia (VAPI is a common complication leading to lengthier hospitalizations and higher mortality. Prompt adequate initial antibiotic coverage is the crucial issue affecting survival. Currently, there is no gold standard diagnostic test. No conclusive data regarding the benefit of bronchoscopy exists in the literature reviewed. AIM: This study aims to evaluate the change of prognosis for patients who developed VAP, following a positive culture from bronchoalveolar lavage (BAL)...
February 2016: Harefuah
Matthew Byrnes, Rob Dorman
BACKGROUND: Gentamicin is used commonly as an empiric antibiotic prior to culture evidence in the treatment of ventilator-associated pneumonia (VAP) in surgical patients. METHODS: The published literature on the use of gentamicin for empiric therapy in VAP was reviewed and in combination with the author's personal experience, an evaluation has been made about the indications for the use of this antibiotic in VAP. RESULTS: Empiric gentamicin use appears to benefit less than 1% of patients in the treatment of presumptive VAP...
June 2016: Surgical Infections
Thomas Tsaganos, Maria Raftogiannis, Maria Pratikaki, Sofia Christodoulou, Anastasia Kotanidou, Evangelos Papadomichelakis, Apostolos Armaganidis, Christina Routsi, Evangelos J Giamarellos-Bourboulis
Increasing numbers of admissions for sepsis impose a heavy burden on health care systems worldwide, while novel therapies have proven both expensive and ineffective. We explored the long-term mortality and hospitalization costs after adjunctive therapy with intravenous clarithromycin in ventilator-associated pneumonia (VAP). Two hundred patients with sepsis and VAP were enrolled in a published randomized clinical trial; 100 were allocated to blind treatment with a placebo and another 100 to clarithromycin at 1 g daily for three consecutive days...
June 2016: Antimicrobial Agents and Chemotherapy
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