Clinics in chest medicine
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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.
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Clinics in chest medicine · Sep 2011
ReviewDiagnosis of ventilator-associated respiratory infections (VARI): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP).
Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia (VAP). ⋯ Extensive data indicate that early, appropriate antibiotic therapy improves outcomes for patients with VAP. Recognizing and treating VARI may allow earlier appropriate therapy and improved patient outcomes.
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Clinics in chest medicine · Sep 2011
ReviewDe-escalation therapy: is it valuable for the management of ventilator-associated pneumonia?
In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overuse and promote even more resistance. In an effort to combat this problem, de-escalation therapy has been proposed, with the goals of reducing the number of drugs, the spectrum of therapy, and the duration of therapy. This review examines the factors associated with an effective de-escalation strategy and ways to increase the rates of de-escalation in the future.
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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.