Nosocomial pneumonia: importance of recognition of aetiological agents to define an appropriate initial empirical therapy

Costa, Sílvia Figueiredo; Newbaer, M.; Santos, C.R.; Basso, Matteo; Soares, Iracy Silvia Corrêa; Levin, Anna S.

doi:10.1016/s0924-8579(00)00316-2

Cited by 22 publications

(14 citation statements)

References 13 publications

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“…The study was approved by the University of Tennessee Institutional Review Board; informed consent was not required. Patients were included in the study if they had documented late-onset GN-VAP that occurred at least 7 days after hospital admission [14,15] but was diagnosed within 5 days of transfer out of the ICU, if they were у18 years of age, and if they had needed mechanical ventilator support. Patients were excluded if they stayed in another hospital 12 days before admission to the ICU or if they had been transferred from the ICU to another hospital's ICU within 2 weeks of admission to the ICU at the Presley Memorial Trauma Center.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

Hanes¹,

Demirkan²,

Tolley³

et al. 2002

CLIN INFECT DIS

132

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Patients with nosocomial pneumonia caused by Stenotrophomonas maltophilia often receive inadequate empiric antibiotic therapy, potentially increasing mortality. Knowledge of the risk factors associated with S. maltophilia pneumonia may better guide the selection of empiric antibiotic therapy. Potential risk factors for S. maltophilia pneumonia were retrospectively analyzed for critically ill trauma patients with late-onset gram-negative pneumonia. The effects of S. maltophilia infection and inadequate empiric antibiotic therapy on patient outcomes were also assessed. By multivariate analysis, S. maltophilia pneumonia was found to be associated with cefepime exposure and tracheostomy in patients with a single pneumonia episode and with higher Injury Severity Score and pulmonary contusion in patients with multiple pneumonia episodes. S. maltophilia pneumonia was associated with increased patient morbidity; only inadequate empiric antibiotic therapy was associated with a higher mortality rate. In critically ill trauma patients with late-onset ventilator-associated pneumonia and these risk factors, empiric antibiotic therapy should include agents active against S. maltophilia.

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Section: Methodsmentioning

confidence: 99%

Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

Hanes¹,

Demirkan²,

Tolley³

et al. 2002

CLIN INFECT DIS

132

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“…Gram-negative agents were responsible for 54% of the pneumonias; individually, S. aureus was the most prevalent pathogen (34%), followed by Acinetobacter baumannii (29%), P. aeruginosa (7%) and Klebsiella pneumoniae (7%). Among the S. aureus strains that were isolated, 68% were MRSA [8].…”

mentioning

confidence: 99%

“…There is evidence that decreases in VAP-related mortality are associated with adequate empirical antimicrobial therapy, defined as: "administration of at least one antimicrobial agent that, in vitro, is effective against bacterial pathogens isolated from respiratory secretion of the patient" [1,4,8,15,16]. In the light of the present stage of microbiological analyses, it is impossible for the physician to determine which pathogen is causing the infection and its resistance profile to antimicrobial agents at the time of the diagnosis and prescription of initial therapy.…”

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confidence: 99%

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Cost-effectiveness of linezolid versus vancomycin in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant staphylococcus aureus

et al. 2005

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“…Staphylococcus aureus, www.infecto.org.br/bjid.htm Enterococcus spp, Pseudomonas aeruginosa) [1]. The past decade has witnessed the development of agents with broad spectrums of in vitro activity and has permitted the option of monotherapy in select patients [2][3][4]. The potential advantages of monotherapy include decreased risk for toxicity and drug interactions, reduced drug expenditures, and other pharmacoeconomic benefits [5][6][7].…”

mentioning

confidence: 99%

A multicenter comparative study of cefepime versus broad-spectrum antibacterial therapy in moderate and severe bacterial infections

Badaró¹,

Molinar²,

Seas³

et al. 2002

Braz J Infect Dis

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The safety and efficacy of cefepime empiric monotherapy compared with standard broad-spectrum combination therapy for hospitalized adult patients with moderate to severe community-acquired bacterial infections were evaluated. In an open-label, multicenter study, 317 patients with an Acute Physiology and Chronic Health Evaluation (APACHE II) score ranging from >5 to =19 were enrolled with documented pneumonia (n=196), urinary tract infection (n=65), intra-abdominal infection (n=38), or sepsis (n=18). Patients were randomly assigned 1:1 to receive cefepime 1 to 2 g IV twice daily or three times a day or IV ampicillin, cephalothin, or ceftriaxone ± aminoglycoside therapy for 3 to 21 days. For both treatment groups, metronidazole, vancomycin, or macrolide therapy was added as deemed necessary. The primary efficacy variable was clinical response at the end of therapy. Two hundred ninety-six (93%) patients met evaluation criteria and were included in the efficacy analysis. Diagnoses included the following: 180 pneumonias (90 cefepime, 90 comparator), 62 urinary tract infections (29 cefepime, 33 comparator), 37 intra-abdominal infections (19 cefepime, 18 comparator), and 17 sepses (8 cefepime, 9 comparator). At the end of therapy, overall clinical success rates were 131/146 (90%) for patients treated with cefepime vs 125/150 (83%) for those treated with comparator (95% confidence interval [CI]: -2.6% to 16.3%). The clinical success rate for patients with community-acquired pneumonia, the most frequent infection, was 86% for both treatment groups. Among the patients clinically evaluated, 162 pathogens were isolated and identified before therapy. The most commonly isolated pathogens were Escherichia coli (n=49), Streptococcus pneumoniae (n=29), Haemophilus influenzae (n=14), and Staphylococcus aureus (n=11). Bacteriologic eradication/presumed eradication was 97% for cefepime vs 94% for comparatortreated patients. Drug-related adverse events were reported in 16% of cefepime patients and 19% of comparator patients. In conclusion, cefepime had higher cure rates compared with broad-spectrum combination therapy as an initial empiric treatment for hospitalized patients with moderate to severe community-acquired infections, including urinary tract infections, intra-abdominal infections, and sepsis. Key Words: Cefepime, ampicillin, caphalotin, ceftriaxone, aminoglycoside, urinary tract infections, intra-abdominal infections, sepsis. The initial selection of an empiric antimicrobial regimen for the treatment of hospitalized patients with serious community-acquired infections requires the use of broadspectrum antibiotics. It has been common practice to treat presumed bacterial infections (e.g. pneumonia, urinary tract infection, sepsis) with combination antibiotic therapy, such as a β-lactam plus an aminoglycoside, in order to cover likely Gram-positive and Gram-negative organisms. In addition, combination therapy is prescribed to provide synergy against difficult-to-treat pathogens or ones that are likely to emerge resistant (e.g...

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Nosocomial pneumonia: importance of recognition of aetiological agents to define an appropriate initial empirical therapy

Cited by 22 publications

References 13 publications

Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

Cost-effectiveness of linezolid versus vancomycin in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant staphylococcus aureus

A multicenter comparative study of cefepime versus broad-spectrum antibacterial therapy in moderate and severe bacterial infections

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