Faculty Opinions recommendation of A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial.

2017 ◽  
Author(s):  
Jean-Francois Timsit
Keyword(s):  
Randomized Trial ◽  
Adjunctive Therapy ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative

A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia

CHEST Journal ◽  
2017 ◽  
Vol 151 (6) ◽  
pp. 1239-1246 ◽  
Author(s):  
Marin H. Kollef ◽  
Jean-Damien Ricard ◽  
Damien Roux ◽  
Bruno Francois ◽  
Eleni Ischaki ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Adjunctive Therapy ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative

Randomized Trial of Combination versus Monotherapy for the Empiric Treatment of Suspected Ventilator-Associated Pneumonia

2018 ◽  
pp. 269-275
Author(s):  
Kimberly Pollock ◽  
Angela Meier
Keyword(s):  
Combination Therapy ◽  
Randomized Trial ◽  
Initial Treatment ◽  
Therapy Group ◽  
Assisted Ventilation ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Mortality Difference

Ventilator associated pneumonia (VAP) is a complication of mechanically assisted ventilation, and the ideal initial treatment strategy is unclear. Heyland et al. explore monotherapy versus combination therapy for the initial treatment of suspected VAP, in a randomized trial of ICU patients with suspected VAP who received either Meropenem in combination with Ciprofloxacin or Meropenem alone. There was no mortality difference between treatment groups, and the duration of intensive care unit and hospitals stays was similar. There was no difference between the clinical and microbiological treatment response or the emergence of antibiotic-resistant bacteria. The adequacy of initial antibiotics was higher in the combination therapy group only in a subgroup of patients infected with difficult-to-treat gram-negative bacteria, but clinical outcomes still did not differ. The authors concluded that, for critically ill patients with suspected VAP, monotherapy is an adequate treatment regimen except for patients at high risk for difficult to treat gram-negative bacteria.

scholarly journals Etiology and resistance patterns of bacteria causing ventilator-associated pneumonia in a respiratory intensive care unit

2017 ◽  
Vol 74 (10) ◽  
pp. 954-962 ◽  
Author(s):  
Vlada Injac ◽  
Uros Batranovic ◽  
Jovan Matijasevic ◽  
Marija Vukoja ◽  
Mirjana Hadnadjev ◽  
...  
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Early Onset ◽  
Late Onset ◽  
Resistance Rate ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Resistance Patterns ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms

Background/Aim. Ventilator-associated pneumonia (VAP) incidence, causative pathogens, and resistance patterns are different among countries and intensive care units (ICUs). In Europe, resistant organisms have progressively increased in the last decade. However, there is a lack of data from Serbian ICUs. The aims of this study were to evaluate etiology and antimicrobial resistance for pathogens causing VAP in ICU patients, to examine whether there were differences among pathogens in early-onset and late-onset VAP and to identify mortality in patients with VAP after 30 and 60 days of hospitalization. Methods. A retrospective cohort study was conducted in the respiratory ICU and all adult patients diagnosed with VAP from 2009 to 2014 were included. Results. Gram negative organisms were the major pathogens (80.3%). The most commonly isolated was Acinetobacter spp (59.8%). There was a statistically significant increase in the incidence of infection with Klebsiella pneumoniae (8.9% vs 25.6%; p = 0.019). Extensively drugresistant strains (XDR) were the most common (78.7%). Lateonset VAP was developed in 81.1% of patients without differences among pathogens in comparison with early-onset VAP. Acinetobacter spp was susceptible to tigecycline and colistin with a significant increase in resistance to ampicillin/sulbactam (30.2% vs 58.6%; p = 0.01). Resistance rate of Pseudomonas aeruginosa and Klebsiella pneumoniae to carbapenems was 38% and 11%, respectively. In methicillin-resistant Staphylococcus aureus no resistance was observed against vancomycin and linezolid. There was no difference in mortality rate between patients with earlyonset and late-onset VAP after 30 and 60 days of hospitalization. Conclusion. Gram negative organisms were the primary cause of bacterial VAP of which the most common was the XDR strain of Acinetobacter spp. Patients with early- and late-onset VAP had the same pathogens. There was no difference in mortality between this two group of patients during 60 days of hospitalization.

Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia*

2008 ◽  
Vol 36 (3) ◽  
pp. 737-744 ◽  
Author(s):  
Daren K. Heyland ◽  
Peter Dodek ◽  
John Muscedere ◽  
Andrew Day ◽  
Deborah Cook
Keyword(s):  
Randomized Trial ◽  
Ventilator Associated Pneumonia ◽  
Empiric Treatment

Comparison of 8 versus 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults

2018 ◽  
pp. 257-262
Author(s):  
Laurie O. Mark ◽  
Jean Kwo
Keyword(s):  
Antibiotic Therapy ◽  
Randomized Trial ◽  
Study Design ◽  
Clinical Case ◽  
Pulmonary Infection ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study “Comparison of 8 versus 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.” In adult patients with ventilator-associated pneumonia (VAP), is treatment with an 8-day course of antimicrobials as effective as a 15-day course? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. In ICU patients who develop microbiologically proven VAP, an 8-day antimicrobial course is not inferior to a 15-day course with respect to all-cause mortality or recurrence of pulmonary infection. However, these findings may not apply to patients who are immunocompromised, and shorter or longer duration of antibiotics may sometimes be indicated.

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