Infectious disease clinics of North America
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The information gathered here helps to explain why risk factors in the development of VAP vary from series to series. It also explains why different investigators have found opposite effects when evaluating the antibiotics. ⋯ These observations suggest that risk factors vary depending on the exposure to risk (ie, length of stay or MV). This variable should be considered when stratifying patients for risk factor analysis and also in the design of clinical trials for VAP prophylaxis.
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Infect. Dis. Clin. North Am. · Dec 2003
ReviewTreatment failures in patients with ventilator-associated pneumonia.
Treatment failures in patients with VAP are a complex issue and form a major challenge for clinicians. The following key elements inherent to a rational approach to treatment failures have been elucidated: (1) the presence of treatment failure must be thoroughly defined and assessed; (2) the many causes behind treatment failures must be realized, particularly the possibility of pneumonia-related and extrapulmonary reasons; (3) the recognition of different patterns of treatment failures as a useful framework for decisions about modalities and intensity of diagnostic reassessment; and (4) the establishment of a protocol for the search of pulmonary and extrapulmonary sites of infection and noninfectious causes of nonresponse. Only such a rational approach precludes the adverse effects of blind empiricism, which always implies a dangerous and costly overtreatment. Many issues related to treatment failures remain unsettled, and efforts will have to be made in the future to improve current clinical attitudes to treatment failures in VAP.
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Infect. Dis. Clin. North Am. · Dec 2003
ReviewAntimicrobial treatment of hospital-acquired pneumonia.
Rapid identification of infected patients and accurate selection of antimicrobial agents for initial treatment of hospital-acquired pneumonia represent important clinical goals, because it seems that better treatment of this infection might have a major impact on hospital-associated mortality and morbidity. Persistently high mortalities for pneumonia in the critical care unit argue, however, for a continued reassessment of the current modalities of therapy and definition of better protocols. ⋯ It should be emphasized that in the event that one or several specific etiologic agents are identified by a reliable technique, the choice of antimicrobial drugs is much easier, because the optimal treatment may be selected in light of the susceptibility pattern of the causative pathogens without resorting to broad-spectrum drugs or risking inappropriate treatment. Great efforts should be placed to obtain reliable pulmonary specimens for direct microscopic examination and cultures in each patient clinically suspected of having developed nosocomial pneumonia before new antibiotics are administered.
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Infect. Dis. Clin. North Am. · Dec 2003
ReviewHospital-acquired pneumonia: diagnostic strategies: lessons from clinical trials.
It should be emphasized that, for the management of VAP, like for all infectious diseases, the choice of antimicrobial treatment is much easier when the specific etiologic agents are identified by a reliable diagnostic technique. Before new antibiotics are administered, reliable pulmonary specimens (chosen according to the literature and within the capabilities of the local microbiology laboratory) must be obtained for direct examination and cultures from patients clinically suspected of having developed VAP.