Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia

Rello, Jordi; Ausina, V.; Ricart, Maite; Castellà, J; Prats, Guillem

doi:10.1378/chest.104.4.1230

Cited by 439 publications

(238 citation statements)

References 23 publications

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“…6 Several authors have reported the association of resistance to β-lactam antibiotics with prior use of third-generation cephalosporins. 7,8 A common mechanism of cephalosporin resistance among Klebsiella spp. and E. coli is the production of ESBL.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Consumption and Development of Resistance among Gram-Negative Bacilli in Intensive Care Units in Oman

2000

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Since the discovery of antimicrobial agents, microorganisms have developed virtually unlimited resistance to them.1 Hospitals and particularly intensive care units are an important breeding ground for the development of antibiotic-resistant bacteria. This is the consequence of heavy antibiotic use. In addition, a high-density patient population in frequent contact with health care staff and the attendant risk of cross-infection contributes to the spread of antibiotic-resistant micro-organisms. This in turn increases the morbidity and mortality associated with infections, and contributes to rising costs of health care.2,3 The aim of this study was to investigate the prevalence of antibiotic resistance among gram-negative bacteria in relation to antibiotic use in the intensive care unit (ICU) at the Royal Hospital, the main referral hospital in Oman. Materials and MethodsThe Royal Hospital is a 630-bed tertiary care hospital consisting of major medical and surgical departments, in addition to specialized units such as intensive care, neonatal, renal, cardiac and oncology. The intensive care unit (ICU) at the Royal Hospital is a general unit admitting both medical and surgical patients, and has a capacity of 12 beds divided between adults and pediatrics. Specimen Collection and Identification of IsolatesOne hundred consecutive gram-negative bacterial isolates from different sites were collected from patients admitted to the adult ICU at the Royal Hospital. The clinical significance of the isolates was confirmed by analysis of patients' records and discussion with the treating clinician. All bacterial strains were identified by their colonial morphology, gram reaction, the oxidized and other biochemical reactions as performed by either API 20E, or API 20NE (bioMerieux, France). Susceptibility TestingThe susceptibilities of the strains to 12 antibiotics (co-amoxiclav, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, aztreonam, piperacillin, piperacillin/tazobactam, imipenem, gentamicin, amikacin, and ciprofloxacin) were performed by determining the minimum inhibitory concentration (MIC), using the E-test (AB BIODISK, Sweden), with E. coli NCTC 10418 and P. aeruginosa NCTC 10662 as controls. The interpretation standards for MICs of the NCCLS were used to determine antibiotic susceptibilities. 4 To detect extended spectrum β-lactamases (ESBL), ceftazidime-resistant strains of E. coli and Klebsiella spp. were further tested against ceftazidime/clavulanic acid. Isolates with a reduction of ceftazidime MIC by >3 two-fold dilutions in the presence of clavulanic acid were considered ESBL producers, and thus resistant to other cephalosporins. Antibiotic ConsumptionThe quantities of antibiotics consumed in the ICU during the period of the study were obtained from the hospital pharmacy records, and the numbers of the patients discharged were obtained from the hospital records. The estimated days of antibiotic treatment were calculated from the antibiotic daily dose, the total amount consumed and the number of patients who lef...

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Section: Discussionmentioning

confidence: 99%

Antibiotic Consumption and Development of Resistance among Gram-Negative Bacilli in Intensive Care Units in Oman

2000

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“…Other independent risk factors include a patient age over 65 years, serum albumin levels lower than 2.2 gr/dL, ARDS, chronic obstructive pulmonary disease, coma and impairment of consciousness, burns, trauma, organ failure, severe critical disease, gastric aspiration at high volume, increase in gastric pH, gastric colonization, sinusitis, paralytic agents, continuous intravenous sedation, positive end expiratory pressure (PEEP), frequent changes of mechanical ventilator cycle, reintubation, nasogastric tube, supine head position, transport from ICU to outside, witholding of antibiotic treatment, or indequate treatment (8)(9)(10)(11)(12)(13)(14)(15). In our study, of the aforementioned risk factors, mechanical ventilation application longer than 48 hours, head trauma, sedation, Table 3.…”

Section: Discussionmentioning

confidence: 99%

GlutamineSupplementedParenteralNutritiontoPreventVentilatorAssociated Pneumonia in the Intensive Care Unit

Aydoğmuş¹,

Tomak²,

Tekïn³

et al. 2012

Balkan Med J

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Objective: Ventilator-associated pneumonia (VAP) is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN). We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU). Material and Methods:With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20), and the second was prescribed TPN (n=20) while the third group was given glutamine-supplemented TPN (n=20). C-reactive protein (CRP), sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs.Results: No statistically significant difference was found among groups in terms of development of VAP (p=0.622). Conclusion:Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP.

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“…We know that more than 2 days of antimicrobial agents can be associated with increased resistance [14], modifying gut flora. Recent information suggests that prevention of VAP can be achieved with one single dose, such as in surgical prophylaxis, adding evidence for appropriate stewardship in the ICU [15].…”

Section: Editorialmentioning

confidence: 99%

Antibiotic prescription for respiratory tract infections in ventilated patients: where are we heading?

Rello

Lipman

2013

Intensive Care Med

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Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia

Cited by 439 publications

References 23 publications

Antibiotic Consumption and Development of Resistance among Gram-Negative Bacilli in Intensive Care Units in Oman

Antibiotic Consumption and Development of Resistance among Gram-Negative Bacilli in Intensive Care Units in Oman

GlutamineSupplementedParenteralNutritiontoPreventVentilatorAssociated Pneumonia in the Intensive Care Unit

Antibiotic prescription for respiratory tract infections in ventilated patients: where are we heading?

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