Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

“…Clinical and radiologic diagnostic criteria have been shown to be inconsistent with autopsy findings (4) and simple laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) are still not recommended, despite some promising results, because of concerns of limited sensitivity and specificity (5). The highest level of certainty for the diagnosis of VAP is thus achieved using "traditional" microbiological data, namely Gram stain examination which is a fast but inaccurate technique (6), and culture-based identification, obtained through a process that has only been slightly altered since it was first developed at the end of the nineteenth century.…”

Inhaled Antibiotics in Reanimatology: Problem State and Development Prospects (Review)

“…Кроме того, в данных рекомендациях указано, что применять ингаляционные антибиотики целесо-образно в тех ситуациях, когда нет клинического ответа на внутривенном режиме антибиотикоте-рапии. Данные мета-анализа IDSA показывают, что использование ингаляционных антибиотиков в качестве дополнения к системным увеличивает частоту разрешения НП (RR 1,29) без влияния на летальность (RR 0,84) или частоту развития по-бочных эффектов (RR 1,11) [41]. В Российских национальных рекоменда-циях «Нозокомиальная пневмония у взрослых» 2016 г. также отмечена целесообразность приме-нения ингаляционных антибиотиков в качестве дополнения к системным.…”

“…Besides, these guidelines mention that it is expedient to apply inhaled antibiotics in situations when there is no clinical response to the intravenous regime of an antibiotic therapy. IDSA meta-analysis shows that use of inhaled antibiotics as adjuvant to systemic therapy increases the rate of NP resolution (RR 1.29) without influence on the case fatality rate (RR 0.84) or the rate of side effects (RR 1.11) [41].…”

“…• systemic side effects of IA -in a number of clinical case descriptions, there were examples of nephro-and ototoxicity when inhaled tobramycin was used; development of systemic side effects might be connected with antibiotic adsorption into blood, which is considerably greater during pneumonia compared to healthy lungs [40][41][42][43];…”

“…• системные побочные эффекты ИА -в ряде описаний клинических случаев были зареги-стрированы примеры нефро-и ототоксичности при использовании ингаляционного тобрамицина; развитие системных побочных эффектов может быть связано с адсобрцией антибиотика в кровь, которая значительно увеличена при пневмонии по сравнению со здоровыми легкими [40][41][42][43];…”