Validation of the American Thoracic Society–Infectious Diseases Society of America Guidelines for Hospital‐Acquired Pneumonia in the Intensive Care Unit

Ferrer, Miquel; Liapikou, Adamantia; Valencia, Mauricio; Esperatti, Mariano; Theessen, Anna; Martínez, José Antonio; Mensa, José; Torres, Antoni

doi:10.1086/651075

Cited by 64 publications

(43 citation statements)

References 31 publications

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“…Our criteria for clinical suspicion of E-HAP are widely accepted. 12,13,16,18,24 Moreover, the retrospective calculation of the mCPIS allowed a positive confirmation of the diagnosis of pneumonia. 24 In unselected populations of mixed ICU patients, an incidence of early-onset pneumonia between 5% and 25% has usually been reported.…”

Section: Discussionmentioning

confidence: 99%

“…12,13,16,18,24 Moreover, the retrospective calculation of the mCPIS allowed a positive confirmation of the diagnosis of pneumonia. 24 In unselected populations of mixed ICU patients, an incidence of early-onset pneumonia between 5% and 25% has usually been reported. [25][26][27][28][29] Our rate of 15.5% among liver recipients agrees with previously reported rates of pneumonia after LT ranging from 5% to 34%.…”

Section: Discussionmentioning

confidence: 99%

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Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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“…Our criteria for clinical suspicion of VAP are widely accepted 37 . Th e period of 4 days was chosen as the inclusion period for diagnosis of early VAP onset as outlined in the current American Th oracic Society/ Infectious Diseases Society of America guidelines 38 .…”

Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Comparing Cadaveric Liver Transplant and Non-Transplant Surgical Patients

Brusich

2016

acc

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SUMMARY -Ventilator-associated pneumonia is a frequent complication in intensive care surgical patients, particularly those with high severity scores on admission. We studied the incidence and clinical outcome of ventilator-associated pneumonia among patients undergoing major general surgery procedures and those undergoing cadaveric liver transplantation in our hospital. Patients with the intensive care unit stay longer than four days having undergone surgery or transplantation and mechanically ventilated for more than 48 hours were included in the study. Ventilator-associated pneumonia diagnosis was based on a combination of radiological signs (progressive infi ltrate on chest radiograph), clinical signs (fever >38.3 °C, leukocytes >12×10 9 /mL) and microbiological data (positive culture from tracheal aspiration >10 5 or bronchoalveolar lavage >10 4 colonies/mL). Medical records of 1037 patients were reviewed and 157 patients were found to have been mechanically ventilated for more than 48 hours: 62 transplanted and 95 non-transplanted. Only 39 (24.84%) patients matched the criteria for ventilator-associated pneumonia. Th ere were no diff erences in sex, age, duration of mechanical ventilation, length of stay or outcome between the two groups. However, the main diff erence was the mean severity score on admission (Simplifi ed Acute Physiology Score II) which was higher among non-transplant patients (42±16 vs. 31±9; p=0.03). Gram-negative bacteria were the leading causative agents (82.03%) and were multidrug-resistant. In the intensive care surgical population, transplantation per se does not seem to increase patient risk for either ventilator-associated pneumonia acquisition or worse outcomes.

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“…Recent clinical investigations of the bacteriological etiology of nosocomial pneumonia indicated that approximately 30-70% of cases had unknown etiology (Bahrani-Mougeot et al 2007;Chung et al 2011;Sopena et al 2014), but the most of them came from ventilator-associated pneumonia (VAP) patients and the data on hospital-acquired pneumonia (HAP) patients is relatively rare (Sopena et al 2014). The precise understanding of bacteriological etiology is important in HAP patients (American Thoracic Society and Infectious Diseases Society of America 2005) for appropriate empirical antimicrobial therapy that is crucial to decrease the mortality and complication rates and the length of hospital stay (Ferrer et al 2010;Jones 2010).…”

Section: Introductionmentioning

confidence: 99%

Determining the Possible Etiology of Hospital-Acquired Pneumonia Using a Clone Library Analysis in Japan

Yatera

Noguchi

Yamasaki

et al. 2017

Tohoku J. Exp. Med.

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Obtaining precise etiological information regarding causative bacteria is important for the proper use of antimicrobials in hospital-acquired pneumonia (HAP), which is associated with a high rate of mortality. The aim of this study was to comparatively investigate the bacterial diversity in bronchoalveolar lavage fluid (BALF) in Japanese patients with HAP by the clone library method using the 16S rRNA gene. This study included Japanese patients with HAP who were treated at our hospital and referring hospitals. BALF specimens were obtained from pneumonia lesions identified on chest radiographs and/or computed tomography. Sputum specimens were also evaluated in patients with sputum production. Sixty-eight patients were ultimately enrolled. BALF cultivation revealed bacterial positivity in 53 of 68 (77.9%) patients, and Staphylococcus aureus (30.9%) was the most frequently isolated, followed by Pseudomonas aeruginosa (16.2%), and Escherichia coli (10.3%). In contrast, the clone library analysis identified the presence of some bacterial phenotype in 65 of 68 (95.6%) patients, and streptococci (16.2%), Corynebacterium species (11.8%), anaerobes (10.3%) were frequently detected as the predominant phylotypes. Both methods tended to detect S. aureus, Klebsiella pneumoniae, and E. coli in patients with late-onset pneumonia. In addition, the cases that phylotypes of S. aureus and P. aeruginosa were found to account for > 5% of the bacterial flora of each case were 42.9% and 72.7%, respectively. These results indicate that attention should be paid to the roles of gram-positive bacilli such as streptococci, Corynebacterium species and anaerobes, in addition to Gram-negative bacilli, in the pathogenesis of HAP.

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Validation of the American Thoracic Society–Infectious Diseases Society of America Guidelines for Hospital‐Acquired Pneumonia in the Intensive Care Unit

Abstract: The 2005 guidelines predict potentially drug-resistant microorganisms worse than the 1996 guidelines. Adherence to guidelines resulted in more adequate treatment and a trend to a better clinical response in group 2, but it did not influence mortality.

Cited by 64 publications

References 31 publications

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Ventilator-Associated Pneumonia: Comparing Cadaveric Liver Transplant and Non-Transplant Surgical Patients

Determining the Possible Etiology of Hospital-Acquired Pneumonia Using a Clone Library Analysis in Japan

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