An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines.

Autor:	Awad LS; Pharmacy Department, Makassed General Hospital., Abdallah DI; Pharmacy Department, Makassed General Hospital., Mugharbil AM; Faculty of Medicine, Beirut Arab University.; Department of Internal Medicine, Division of Hematology-Oncology., Jisr TH; Faculty of Medicine, Beirut Arab University.; Department of Laboratory Medicine., Droubi NS; Pharmacy Department, Makassed General Hospital., El-Rajab NA; Department of Internal Medicine., Moghnieh RA; Faculty of Medicine, Beirut Arab University.; Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital.; Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Jazyk:	angličtina
Zdroj:	Infection and drug resistance [Infect Drug Resist] 2017 Dec 22; Vol. 11, pp. 17-28. Date of Electronic Publication: 2017 Dec 22 (Print Publication: 2018).
DOI:	10.2147/IDR.S145827
Abstrakt:	Introduction: Management of ventilator-associated pneumonia (VAP), the most common infection in patients on mechanical ventilation, should be tailored to local microbiological data. The aim of this study was to determine susceptibility patterns of organisms causing VAP to develop a treatment algorithm based on these findings and evidence from the literature. Materials and Methods: This is a retrospective analysis of the microbiological etiology of VAP in the intensive care unit (ICU) of a Lebanese tertiary care hospital from July 2015 to July 2016. We reviewed the latest clinical practice guidelines on VAP and tried to adapt these recommendations to our setting. Results: In all, 43 patients with 61 VAP episodes were identified, and 75 bacterial isolates caused VAP. Extensively drug-resistant (XDR) Acinetobacter baumannii was the most common organism (37%), and it had occurred endemically throughout the year. Pseudomonas aeruginosa was the next most common organism (31%), and 13% were XDR. Enterobacteriaceae (15%) and Stenotrophomonas maltophilia (12%) shared similar incidences. Our algorithm was based on guidelines, in addition to trials, systematic reviews, and meta-analyses that studied the effectiveness of available antibiotics in treating VAP. Conclusion: Knowing that resistance can rapidly develop within a practice environment, more research is needed to identify the best strategy for the management of VAP. Competing Interests: Disclosure The authors report no conflicts of interest in this work.
Databáze:	MEDLINE
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