Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impact on patient care.
Hospital-acquired pneumonia is a common nosocomial infection, with significant morbidity and mortality, and represents a major therapeutic challenge to clinicians. The therapeutic approach must be patient-oriented and institution-specific. The specific risk factors of each patient, such as previous antibiotic exposure, underlying diseases, length of hospital stay and the local patterns of antimicrobial resistance, should guide physicians in their decision of the initial optimal empirical therapy. Delays in the initiation or inappropriate/inadequate initial therapy are related to increased mortality and worse outcomes. In responding patients, as soon as culture data are available, efforts should be made to change the initial broad spectrum antibiotic regimen to a more targeted one (de-escalation). The optimal duration of treatment is a matter of debate, but courses longer than 1 week are rarely justified.
Koulenti
Despoina
D
Critical Care Department, Joan XXIII University Hospital/ Institut Pere Virgili, Mallafre Guasch, 4, 43007 Tarragona, Spain. deskogr@yahoo.gr
Rello
Jordi
J
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000280:Administration, Inhalation; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015780:Carbapenems / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D016106:Methicillin Resistance; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D014640:Vancomycin