Consensus document on controversial issues for the treatment of hospital-associated pneumonia.
BACKGROUND
Hospital-associated pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. Many aspects of the treatment of HAP caused by multi-resistant Gram-positive microorganisms have been extensively studied, but controversial issues remain.


OBJECTIVE
The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Is combination antibiotic therapy or monotherapy more effective in the treatment of HAP? (2) What role do pharmacokinetic/pharmacodynamic antibiotic features have as a guide in the selection of treatment for HAP? (3) Is a de-escalation approach for the management of HAP effective? An analysis of the studies published up until April 2009 is presented and discussed in detail.


METHODS
A systematic literature search using PubMed, MEDLINE, and EMBASE databases and the Cochrane Library was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence was applied.
Franzetti
Fabio
F
Clinica Universitaria di Malattie Infettive e Tropicali, Azienda Ospedaliera Universitaria Luigi Sacco, Università degli Studi di Milano, Milano, Italy. fabio.franzetti@unimi.it
Antonelli
Massimo
M
Bassetti
Matteo
M
Blasi
Francesco
F
Langer
Martin
M
Scaglione
Francesco
F
Nicastri
Emanuele
E
Lauria
Francesco N
FN
Carosi
Giampiero
G
Moroni
Mauro
M
Ippolito
Giuseppe
G
D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents