The importance of de-escalating antimicrobial therapy in patients with ventilator-associated pneumonia

Seminars in Respiratory and Critical Care Medicine
M S Niederman

Abstract

The management of ventilator-associated pneumonia (VAP) requires a strategy for antibiotic use that achieves prompt and accurate empirical therapy without overusing antibiotics. Although, efforts at better diagnosis and antibiotic restriction have been attempted, "de-escalation" may be a more useful and effective strategy, and one that can achieve these goals while improving patient outcomes. The centerpiece of this approach is to initiate empirical therapy with a broad-spectrum treatment regimen, based on knowledge of local patterns of microbiology and antimicrobial resistance. Prior to therapy, patients require collection of a lower respiratory tract sample for culture. After 2 to 3 days, the clinical course can be assessed and the culture data reviewed, and in responding patients, efforts can be made to change the initial broad-spectrum therapy. This de-escalation can involve focusing to a more narrow spectrum agent, reducing the number of antibiotics, stopping therapy altogether in patients not likely to have infection, and making efforts to reduce duration of therapy. When this strategy has been used, outcomes such as the frequency of secondary infection, antimicrobial resistance, and mortality have improved. Additional in...Continue Reading

Citations

Jun 6, 2007·Intensive Care Medicine·Elpis GiantsouKonstantinos Manolas
May 6, 2008·Critical Care : the Official Journal of the Critical Care Forum·Saad NseirUNKNOWN VAT Study Group
Jun 3, 2014·BMC Infectious Diseases·Marina KoupetoriUNKNOWN Hellenic Sepsis Study Group
Dec 30, 2015·Surgical Infections·Kristin C TurzaRobert G Sawyer
Jul 9, 2013·Critical Care Clinics·Girish B Nair, Michael S Niederman
Aug 27, 2011·Clinics in Chest Medicine·Michael S Niederman, Vasiliki Soulountsi
Aug 27, 2011·Clinics in Chest Medicine·Andrew Labelle, Marin H Kollef
Jan 1, 2012·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Keith S Kaye
Aug 22, 2009·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·S NseirA Durocher
Aug 5, 2010·Critical Care Medicine·Tejal N GandhiLaraine L Washer
Aug 24, 2006·Current Opinion in Pulmonary Medicine·Thiago Lisboa, Jordi Rello
Jun 16, 2009·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Robert C OwensAndrea L Deschambeault
Jan 14, 2011·Current Opinion in Infectious Diseases·David P Nicolau
Sep 16, 2009·Expert Opinion on Pharmacotherapy·Caroline SabatierJordi Vallés
Jun 24, 2017·International Journal of Clinical Pharmacy·Rahela Ambaras Khan, Zoriah Aziz
May 27, 2010·Hospital Practice·Alpesh Amin, Marin H Kollef
Feb 25, 2021·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Alessio StrazzullaSylvain Diamantis
Jan 1, 2012·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Keith S Kaye

❮ Previous
Next ❯

Related Concepts

Related Feeds

Bacterial Pneumonia

Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. Here is the latest research.

Antimicrobial Resistance (ASM)

Antimicrobial resistance poses a significant threat to the continued successful use of antimicrobial agents for the treatment of bacterial infections.

Bacterial Pneumonia (ASM)

Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. Here is the latest research.

Antifungals (ASM)

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.

Antimicrobial Resistance

Antimicrobial resistance poses a significant threat to the continued successful use of antimicrobial agents for the treatment of bacterial infections.

Antifungals

An antifungal, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis, cryptococcal meningitis, and others. Discover the latest research on antifungals here.