Therapy of ventilator-associated pneumonia

Sandiumenge, Alberto; Dı́az, Emili; Bodí, M.; Rello, Jordi

doi:10.1007/s00134-003-1715-1

Cited by 146 publications

(13 citation statements)

References 52 publications

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“…The best description for the antibiotic treatment in the future has been summarized by the "Tarragona strategy" (Table 7 "Tarragona strategy") [67]. The initial empiric antibiotic therapy should be calculated according to the individual patients' risk factors, with respect to the hospital specific surveillance data.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

2010

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The management of severe intra-abdominal infections remains a major challenge facing surgeons and intensive care physicians, because of its association with high morbidity and mortality. Surgical management and intensive care medicine have constantly improved, but in the recent years a rapidly continuing emergence of resistant pathogens led to treatment failure secondary to infections with multi-drug resistant bacteria. In secondary peritonitis the rate of resistant germs at the initial operation is already 30%. The lack of effective antibiotics against these pathogens resulted in the development of new broad-spectrum compounds and antibiotics directed against resistant germs. But so far no "super-drug" with efficacy against all resistant bacteria exists. Even more, soon after their approval, reports on resistance against these novel drugs have been reported, or the drugs were withdrawn from the market due to severe side effects. Since pharmaceutical companies reduced their investigations on antibiotic research, only few new antimicrobial derivates are available.In abdominal surgery you may be in fear that in the future more and more patients with tertiary peritonitis secondary to multi-drug resistant species are seen with an increase of mortality after secondary peritonitis.This article reviews the current treatment modalities for complicated intra-abdominal infections with special reference to the antibiotic treatment of complicated intra-abdominal infections with multi-drug resistant species.

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Section: Discussionmentioning

confidence: 99%

Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

2010

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“…Fast and adequate antimicrobial therapy is crucial in these patients, and clinical studies have unequivocally shown that inappropriate initial treatment results in up to a five-fold increase in mortality; this increase is most dramatic in patients with septic shock [2], [3]. Reasons for inappropriate treatment include i) failure to correctly cover the underlying pathogen, ii) choosing an anti-infective with poor penetration into the infectious focus, and iii) underdosing.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Polymerase Chain Reaction Assay for Pathogen Detection in Septic Patients under Routine Condition: An Observational Study

et al. 2012

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BackgroundTreatment of septic shock relies on appropriate antimicrobial therapy. Current culture based methods deliver final results after days, which may delay potentially lifesaving adjustments in antimicrobial therapy. This study was undertaken to compare PCR with blood culture results under routine conditions regarding 1. impact on antimicrobial therapy, and 2. time to result, in patients with presumed sepsis.Methodology/Principal FindingsThis was an observational study in a 50 beds ICU of a university hospital. In 245 patients with suspected sepsis, 311 concomitant blood cultures and blood for multiplex PCR (VYOO®) were obtained. 45 of 311 blood cultures (14.5%) and 94 of 311 PCRs (30.1%) were positive. However, blood culture or microbiological sampling from the presumed site of infection rarely confirmed PCR results and vice versa. Median time to positivity and interquartile range were 24.2 (18.0, 27.5) hours for the PCR and 68 (52.2, 88.5) hours for BC (p<0.01). PCR median time to result was dependent on technician availability (53.5 hours on Saturdays, 7.2 hours under optimal logistic conditions). PCR results showed good correlation with procalcitonin (p<0.001). In 34% of patients with positive PCRs antimicrobial therapy was considered inadequate according to assessment of clinical arbitrators including 5 patients with vancomycin-resistant enterococci (VRE), 3 cases with multiresistant staphylococci, and 4 patients with fungi.ConclusionsThe results of this observational study support the hypothesis that PCR results are available faster, are more frequently positive, and may result in earlier adjustment of antimicrobial therapy. However, shorter time to result can only be fully exploited when the laboratory is adequately staffed for a 24 hour/7 day service, or when point of care/automated assay systems become available.

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“…Bei dieser Individualisierung haben sich die sog. Tarragona-Kriterien bewährt, die im Folgenden kurz zusammengefasst sind [14]:…”

Section: Grundsätze Der Antibiotikatherapie Bei Sepsisunclassified

Infektiologische Notfälle – Fokus Sepsis

Götze¹,

Riessen²

2019

Notf.med. up2date

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Therapy of ventilator-associated pneumonia

Cited by 146 publications

References 52 publications

Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

Evaluation of a Polymerase Chain Reaction Assay for Pathogen Detection in Septic Patients under Routine Condition: An Observational Study

Infektiologische Notfälle – Fokus Sepsis

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