Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

“…5,19 Guideline concordant therapy was defined as triple coverage with both anti-MRSA and two anti-pseudomonal antibiotics which is different than our study. Similarly, we did not establish benefit with triple therapy in the interaction between CAPresistance and treatment or in the ecological analysis.…”

“…5,[14][15][16][17][18][19] El Sohl et. al retrospectively stratified 344 nursing home patients based on treatment with HCAP or CAP guideline concordant therapy.…”

“…[2][3][4] Recently, an intervention to improve guidelinebased treatment of patients with possible MDR pneumonia including HCAP, found that guideline-adherent therapy was associated with increased mortality. 5 Therefore, it is unclear if guideline-based therapy improves outcomes for patients with HCAP. The primary objective was to compare the 30-day mortality of patients that received guideline-based therapy to those that received alternative therapy.…”

Risk Factors for Mixed Complicated Skin and Skin Structure Infections To Help Tailor Appropriate Empiric Therapy

“…Although these definitions have been incorporated into evidence-based practice guidelines [25], they have never been validated. Furthermore, emerging evidence suggests that the HCA definition's lack of specificity results in more permissive use of broad-spectrum antibiotics, thus heightening concerns about selective pressure to promote further resistance and even to worsen individual patient outcomes [26].…”

Healthcare-associated pneumonia: another nail in the coffin?

“…In addition, geographic variability, in terms of both organization of healthcare delivery and microbial ecology, may limit the validity of the original HCAP definition to identify a patient population requiring broader antimicrobial coverage than what is suggested for CAP. Whereas compliance with CAP guidelines, including ATS-IDSA guidelines prior to the introduction of HCAP, has been shown to be associated with improved outcome [9], this was not the case for adherence to the new ATS-IDSA guidelines which include recommendations for HCAP [10]. Taken together with the notion that the broad definition of HCAP results in high numbers of ''communityonset'' pneumonia episodes fulfilling HCAP criteria (up to 50 % in some tertiary centers) [11], these results raise the concern that adoption of the ATS-IDSA recommendations with respect to HCAP would lead to unjustified antibiotic escalation in a time when antibiotic use instead needs to be restrained to reduce further selection pressure.…”