De-Escalation Therapy: Is It Valuable for the Management of Ventilator-Associated Pneumonia?

被引:38
作者
Niederman, Michael S. [1 ,2 ,4 ]
Soulountsi, Vasiliki [2 ,3 ]
机构
[1] SUNY Stony Brook, Dept Med, Stony Brook, NY 11794 USA
[2] Winthrop Univ Hosp, Dept Pulm & Crit Care Med, Mineola, NY 11501 USA
[3] Gen Hosp G Papanikolaou, Dept AICU, Kifisia Thessaloniki 54248, Greece
[4] Winthrop Univ Hosp, Dept Med, Mineola, NY 11501 USA
关键词
De-Escalation; Antimicrobial resistance; Ventilator-associated pneumonia (VAP) therapy; Therapeutic protocols; INTENSIVE-CARE UNITS; ANTIBIOTIC-THERAPY; NOSOCOMIAL PNEUMONIA; BRONCHOALVEOLAR LAVAGE; EMPIRIC TREATMENT; MULTICENTER; IMPACT; TRIAL; PROCALCITONIN; COMBINATION;
D O I
10.1016/j.ccm.2011.05.009
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
In therapy for ventilator-associated pneumonia, it is essential to get initial empiric therapy correct; this is challenging because many patients are infected with multidrug-resistant pathogens. The need for achieving appropriate therapy can lead to broad-spectrum empiric therapy, which can represent antibiotic overuse and promote even more resistance. In an effort to combat this problem, de-escalation therapy has been proposed, with the goals of reducing the number of drugs, the spectrum of therapy, and the duration of therapy. This review examines the factors associated with an effective de-escalation strategy and ways to increase the rates of de-escalation in the future.
引用
收藏
页码:517 / +
页数:20
相关论文
共 50 条
[1]   Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study [J].
Alvarez-Lerma, Francisco ;
Alvarez, Bernabe ;
Luque, Pilar ;
Ruiz, Francisco ;
Dominguez-Roldan, Jose-Maria ;
Quintana, Elisabet ;
Sanz-Rodriguez, Cesar .
CRITICAL CARE, 2006, 10 (03)
[3]  
[Anonymous], JAMA
[4]  
[Anonymous], 2008, AM J RESP CRIT CARE, DOI DOI 10.1164/rccm.200708-1238OC
[5]  
Baughman Robert P, 2003, J Intensive Care Med, V18, P269, DOI 10.1177/0885066603256012
[6]   Using local microbiologic data to develop institution-specific guidelines for the treatment of hospital-acquired pneumonia [J].
Beardsley, James R. ;
Williamson, John C. ;
Johnson, James W. ;
Ohl, Christopher A. ;
Karchmer, Tobi B. ;
Bowton, David L. .
CHEST, 2006, 130 (03) :787-793
[7]   Effect of aminoglycoside and β-lactam combination therapy versus β-lactam monotherapy on the emergence of antimicrobial resistance:: A meta-analysis of randomized, controlled trials [J].
Bliziotis, IA ;
Samonis, G ;
Vardakas, KZ ;
Chrysanthopoulou, S ;
Falagas, ME .
CLINICAL INFECTIOUS DISEASES, 2005, 41 (02) :149-158
[8]   Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial [J].
Bouadma, Lila ;
Luyt, Charles-Edouard ;
Tubach, Florence ;
Cracco, Christophe ;
Alvarez, Antonio ;
Schwebel, Carole ;
Schortgen, Frederique ;
Lasocki, Sigismond ;
Veber, Benoit ;
Dehoux, Monique ;
Bernard, Maguy ;
Pasquet, Blandine ;
Regnier, Bernard ;
Brun-Buisson, Christian ;
Chastre, Jean ;
Wolff, Michel .
LANCET, 2010, 375 (9713) :463-474
[9]   Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: A multicenter, randomized study [J].
Chastre, Jean ;
Wunderink, Richard ;
Prokocimer, Philippe ;
Lee, Michael ;
Kaniga, Kone ;
Friedland, Ian .
CRITICAL CARE MEDICINE, 2008, 36 (04) :1089-1096
[10]   Development of a guideline for the management of ventilator-associated pneumonia based on local microbiologic findings and impact of the guideline on antimicrobial use practices [J].
Dellit, Timothy H. ;
Chan, Jeannie D. ;
Skerrett, Shawn J. ;
Nathens, Avery B. .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2008, 29 (06) :525-533