Do guidelines change outcomes in ventilator-associated pneumonia?

Bassi, Gianluigi Li; Ferrer, Miguel; Saucedo, Lina María; Torres, Antoni

doi:10.1097/qco.0b013e328337241a

Cited by 14 publications

(18 citation statements)

References 37 publications

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“…VAP is the most important infection in the ICU associated with significant increases in mortality, cost and length of hospital stay (Bassi et al, 2010;Davis, 2006;Park, 2005) and is responsible for about 6-52 % of ICU infections (Davis, 2006). In this study, we investigated a cohort of 157 patients with bacteraemia and 60 with P. aeruginosa VAP.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

Ferreira

Dantas

Faria

et al. 2015

Journal of Medical Microbiology

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This study evaluated the predictors of mortality and the impact of inappropriate therapy on the outcomes of patients with bacteraemia and ventilator-associated pneumonia (VAP). Additionally, we evaluated the correlation of the type III secretion system (TTSS) effector genotype with resistance to carbapenems and fluoroquinolones, mutations in the quinolone resistancedetermining regions (QRDRs), metallo-b-lactamase and virulence factors. A retrospective cohort was conducted at a tertiary hospital in patients with multidrug-resistant (MDR) P. aeruginosa bacteraemia (157 patients) and VAP (60 patients). The genes for bla IMP , bla VIM , bla SIM , bla GIM and bla SPM and virulence genes (exoT, exoS, exoY, exoU, lasB, algD and toxA) were detected; sequencing was conducted for QRDR genes on fluoroquinolone-resistant strains. The multivariate analyses showed that the predictors independently associated with death in patients with bacteraemia were cancer and inappropriate therapy. Carbapenem resistance was more frequent among strains causing VAP (53.3 %), and in blood we observed the bla SPM genotype (66.6 %) and bla VIM genotype (33.3 %). The exoS gene was found in all isolates, whilst the frequency was low for exoU (9.4 %). Substitution of threonine to isoleucine at position 83 in gyrA was the most frequent mutation among fluoroquinolone-resistant strains. Our study showed a mutation at position 91 in the parC gene (Glu91Lys) associated with a mutation in gyrA (Thre83Ile) in a strain of extensively drug-resistant P. aeruginosa, with the exoT + exoS + exoU + genotype, that has not yet been described in Brazil to the best of our knowledge. This comprehensive analysis of resistance mechanisms to carbapenem and fluoroquinolones and their association with TTSS virulence genes, covering MDR P. aeruginosa in Brazil, is the largest reported to date. INTRODUCTIONSevere infections such as bloodstream infection and ventilator-associated pneumonia (VAP) due to multidrugresistant (MDR) Pseudomonas aeruginosa result in greater morbidity and mortality, longer hospitalization and higher cost than infections caused by susceptible bacteria (Morales et al., 2012; Suárez et al., 2010;Voor In't Holt et al., 2014), and aspects related to epidemiology and the outcome of patients with these infections may change, resulting in high rates of resistance and as consequence difficulties in treatment (Kang et al., 2005; Lodise et al., 2007).Today, the emergence of MDR P. aeruginosa is a global problem (Sader et al., 2001; Van der Bij et al., 2011, resulting in the ability of this pathogen to develop resistance to almost all available antibiotics, either by selection of mutations in chromosomal genes or from horizontal gene transfer (Breidenstein et al., 2011). In Brazil this problem is hih5ghly significant and some studies show a very high density of antibiotic use, especially of carbapenems and fluoroquinolones (Moreira et al., 2013;Porto et al., 2013). The resistance of P. aeruginosa to carbapenems is higher than 60 % in some Brazilian hospitals ...

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Section: Discussionmentioning

confidence: 99%

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

Ferreira

Dantas

Faria

et al. 2015

Journal of Medical Microbiology

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“…Treatment guidelines or clinical pathways can improve outcomes related to mortality, length of hospital stay and duration of treatment [ 90 , 91 ]. High adherence to guidelines or clinical pathways, e.g.…”

Section: Recommendations Of the Guidelinementioning

confidence: 99%

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

et al. 2016

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IntroductionIn the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.Materials and methodsA structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.ConclusionThe guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.

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“…Provide educational materials to staff that summarize the evidence, support self-study, and remind staff about new practices. 231 Examples of educational materials include pocket cards, brochures, posters, fact sheets, daily guides, guideline summaries, flow sheets and 1-page bulletins. 173 ' 205,207 ' 227 ' 229,232 III.…”

Section: Educatementioning

confidence: 99%

Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update

Klompas

Branson

Eichenwald³

et al. 2014

Infect. Control Hosp. Epidemiol.

162

118

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Do guidelines change outcomes in ventilator-associated pneumonia?

Abstract: Guidelines implementation can improve outcomes. To achieve this goal, guidelines should be adapted to local microbiology, accurately predict VAP pathogens and help physicians to administer the most appropriate empirical antimicrobial therapy.

Cited by 14 publications

References 37 publications

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update

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