Clinics in chest medicine
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Clinics in chest medicine · Sep 2011
ReviewOptimizing antibiotic pharmacodynamics in hospital-acquired and ventilator-acquired bacterial pneumonia.
Nosocomial pneumonia carries a high morbidity and mortality and creates a large burden on health care use. As resistance to currently available antibiotics continues to increase, the role of pharmacodynamics in drug regimen optimization becomes pivotal to the clinical success of patient therapy. This article reviews the evidence behind pharmacodynamic optimization including the use of Monte Carlo simulations, changes in pharmacokinetic parameters of critically ill patients, and differing strategies to optimize drug regimens. Emphasis is placed on drugs used to treat hospital-acquired and ventilator-acquired pneumonia, and programs implementing pharmacodynamic optimization are highlighted.
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Pneumonia is an important clinical and public health problem. Identification and prediction of severe pneumonia are significant concerns. Attempts to define severe pneumonia should recognize that different purposes are served by different definitions; no single definition meets all needs. ⋯ Biomarkers are not yet ready for routine use. The authors recommend careful consideration of the implications of any given definition of pneumonia severity. Outcome studies are needed to integrate human and health care system factors with the application of pneumonia severity definitions.
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Clinics in chest medicine · Sep 2011
ReviewThe impact of guidelines on the outcomes of community-acquired and ventilator-associated pneumonia.
The correct implementation of the current guidelines for the management of community-acquired pneumonia is associated with less mortality, faster clinical stabilization, and lower costs in these patients. By contrast, implementing the current guidelines for the management of hospital-acquired pneumonia has been followed by an increase in initially adequate antibiotic treatment but has not been accompanied by a consistently improved outcome in patients.
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Clinics in chest medicine · Sep 2011
ReviewHealthcare-associated pneumonia: approach to management.
Healthcare-associated pneumonia patients have worse outcomes and a different microbiologic profile than those with community-acquired pneumonia, including a greater risk for multidrug-resistant (MDR) organism infection. Risks include hospitalization for 2 or more days within 90 days, presentation from a nursing home or long-term care facility, attending a hospital or hemodialysis clinic, receiving intravenous therapy within 30 days, and immunosuppression. Ability to predict infection with MDR organisms varies, and the relative frequency of MDR organisms varies by geographic region. Initial treatment is broad-spectrum empiric antibiotics.
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Infection prevention measures, specifically targeting ventilator-associated pneumonia (VAP), have been purposed as quality-of-care indicators for patients in intensive care units. The authors discuss some of the recent evidence of the prevention of nosocomial infections, with a particular emphasis on VAP. Moreover, there are several pitfalls in considering VAP rates as a safety indicator. Because of these limitations, the authors recommend the use of specific process measures, designed to reduce VAP, as the basis for interinstitutional benchmarking.