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Titolo:
Antibacterial treatment of invasive mechanical ventilation-associated pneumonia
Autore:
Barcenilla, F; Gasco, E; Rello, J; Alvarez-Rocha, L;
Indirizzi:
Hosp Univ Arnau de Vilanova, Serv Med Intens, Lleida 25198, Spain Hosp Univ Arnau de Vilanova Lleida Spain 25198 tens, Lleida 25198, Spain Hosp Univ Juan XXIII, Serv Med Intens, Tarragona, Spain Hosp Univ Juan XXIII Tarragona Spain Serv Med Intens, Tarragona, Spain Complexo Hosp Juan Canalejo, Serv Med Intens, A Coruna, Spain Complexo Hosp Juan Canalejo A Coruna Spain Med Intens, A Coruna, Spain
Titolo Testata:
DRUGS & AGING
fascicolo: 3, volume: 18, anno: 2001,
pagine: 189 - 200
SICI:
1170-229X(2001)18:3<189:ATOIMV>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS SYNDROME; CRITICALLY ILL PATIENTS; INTENSIVE-CARE UNITS; NOSOCOMIAL PNEUMONIA; NONNEUTROPENIC PATIENTS; PSEUDOMONAS-AERUGINOSA; ANTIMICROBIAL THERAPY; STAPHYLOCOCCUS-AUREUS; HOSPITALIZED-PATIENTS; MORTALITY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
62
Recensione:
Indirizzi per estratti:
Indirizzo: Barcenilla, F Hosp Univ Arnau de Vilanova, Serv Med Intens, Rovira Roura 80, Lleida 25198, Spain Hosp Univ Arnau de Vilanova Rovira Roura 80 Lleida Spain 25198
Citazione:
F. Barcenilla et al., "Antibacterial treatment of invasive mechanical ventilation-associated pneumonia", DRUG AGING, 18(3), 2001, pp. 189-200

Abstract

Patients admitted to intensive care units (ICU) are at higher risk of acquiring nosocomial infections than patients in other hospital areas. This is the consequence of both a greater severity of illness with its implications(manipulation, invasiveness) and crossed infection from reservoirs inside the ICU. The most frequent nosocomial infection is invasive ventilation-associated pneumonia (VAP) which leads to an important increase in morbidity and mortality. The most important aetiological agents in VAP are bacteria, with a marked predominance of Staphylococcus aureus and Pseudomonas aeruginosa. These aetiologies may be different depending upon the type of ICU (medical, surgical, coronary) or the presence of certain risk factors (duration of mechanical ventilation before onset of pneumonia, previous exposure to antibacterials). Susceptibilities of the aetiological agents to antibacterials may also vary according to the type of ICU and over time. Data from global studies show an increase in multiresistant bacteria but these data may not be applied to a local ICU. The availability of accurate and updated information on the most frequently encountered organisms in each ICU and their susceptibilities is very important in order to provide the most adequate treatment. A controversial issue is the selection of antibacterials. According to thelatest evidence the most adequate approach is a prompt administration of empirical treatment. Based on knowledge of bacterial flora in our own ICU, the choice of an adequate therapeutic regimen will decrease both morbidity and mortality. A second issue is monotherapy versus combined therapy. The most common recommendation, with a few exceptions, is to use combined therapy until microbiological results are received. Another controversy is the choice of antibacterials in the combined regimen. The mast commonly recommended combination is that of a beta -lactam withan aminoglycoside, except in early-onset pneumonia without risk factors. The use of monotherapy with a cefalosporin without antipseudomonal activity or amoxicillin-clavulanic acid is the recommended regimen. Treatment should be modified based on microbiological results. There are no well documented recommendations on the prophylactic duration of treatmentand it must be based on the aetiological agent and the clinical course. In summary treatment of VAP must be prompt, empirical and combined (beta -lactam plus aminoglycoside). However, the choice of the antibacterial regimen should follow local guidelines of treatment based upon the knowledge of the most frequently isolated bacterial flora and their susceptibilities in different clinical settings.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/01/20 alle ore 15:22:22