Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Ventilator-associated pneumonia (VAP) rates are advocated as a measure of hospitals' quality of care for critically ill patients. The standard definition used to measure VAP rates, however, is constructed of nonspecific clinical signs common to many common complications of critical care. We created a model in which we estimated the probability of patients with 6 different complications of critical care fulfilling diagnostic criteria for VAP. ⋯ Despite keeping the true, underlying prevalence of VAP fixed at 10%, the apparent rate of VAP varied between 6.0% and 31.6%, depending on the prevalence of other conditions. The addition of microbiological criteria to standard clinical criteria decreased the range of apparent VAP to 3.5%-15.5%. These wide margins of variability suggest that VAP rates are an unreliable measure of quality of care.
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Randomized Controlled Trial Multicenter Study
Effect of clarithromycin in patients with sepsis and ventilator-associated pneumonia.
Because clarithromycin provided beneficiary nonantibiotic effects in experimental studies, its efficacy was tested in patients with sepsis and ventilator-associated pneumonia (VAP). ⋯ Clarithromycin accelerated the resolution of VAP and weaning from mechanical ventilation in surviving patients and delayed death in those who died of sepsis. The mortality rate at day 28 was not altered. Results are encouraging and render new perspectives on the management of sepsis and VAP.
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Candida albicans has been the most common cause of fungal bloodstream infections (BSIs) in intensive care units (ICUs); however, infections due to non-albicans Candida species have been increasing in prevalence. We examined factors associated with BSIs due to non-albicans Candida species, compared with C. albicans BSIs, in an ICU patient population. ⋯ Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.