Empiric Treatment in HAP/VAP: "Don't You Want to Take a Leap of Faith?"

被引:9
作者
Chaibi, Khalil [1 ,2 ]
de Ponfilly, Gauthier Pean [3 ,4 ]
Dortet, Laurent [5 ,6 ]
Zahar, Jean-Ralph [7 ]
Pilmis, Benoit [4 ,8 ]
机构
[1] Univ Sorbonne Paris Nord, Hop Avicenne, AP HP, Dept Reanimat Med Chirurg, F-93000 Bobigny, France
[2] Sorbonne Univ, INSERM, Common & Rare Kidney Dis, UMR S 1155, F-75020 Paris, France
[3] Grp Hosp Paris St Joseph, Serv Microbiol Clin, F-75014 Paris, France
[4] Univ Paris Saclay, Inst Micalis, Unite Mixte Rech 1319, AgroParisTech,INRAe, F-92290 Chatenay Malabry, France
[5] CHU Bicetre, AP HP, Serv Bacteriol Hyg, Ctr Natl Reference Resistance Antibiot, F-94270 Le Kremlin Bicetre, France
[6] Univ Paris Saclay, Resist Unit, INSERM UMR1184, F-94270 Le Kremlin Bicetre, France
[7] Univ Sorbonne Paris Nord, Hop Avicenne, AP HP, Infect Control Unit, F-93000 Bobigny, France
[8] Grp Hosp Paris St Joseph, Equipe Mobile Microbiol Clin, F-75014 Paris, France
来源
ANTIBIOTICS-BASEL | 2022年 / 11卷 / 03期
关键词
antibiotic choices; HAP; VAP; colonization; antibiotic pressure; VENTILATOR-ASSOCIATED PNEUMONIA; INTENSIVE-CARE UNITS; CARBAPENEM-RESISTANT ENTEROBACTERIACEAE; LACTAMASE-PRODUCING ENTEROBACTERIACEAE; COMMUNITY-ACQUIRED PNEUMONIA; RELATIVE FECAL ABUNDANCE; FOR-DISEASE-CONTROL; RISK-FACTORS; BETA-LACTAMASE; PSEUDOMONAS-AERUGINOSA;
D O I
10.3390/antibiotics11030359
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Ventilator-associated pneumonia is a frequent cause of ICU-acquired infections. These infections are associated with high morbidity and mortality. The increase in antibiotic resistance, particularly among Gram-negative bacilli, makes the choice of empiric antibiotic therapy complex for physicians. Multidrug-resistant organisms (MDROs) related infections are associated with a high risk of initial therapeutic inadequacy. It is, therefore, necessary to quickly identify the bacterial species involved and their susceptibility to antibiotics. New diagnostic tools have recently been commercialized to assist in the management of these infections. Moreover, the recent enrichment of the therapeutic arsenal effective on Gram-negative bacilli raises the question of their place in the therapeutic management of these infections. Most national and international guidelines recommend limiting their use to microbiologically documented infections. However, many clinical situations and, in particular, the knowledge of digestive or respiratory carriage by MDROs should lead to the discussion of the use of these new molecules, especially the new combinations with beta-lactamase inhibitors in empirical therapy. In this review, we present the current epidemiological data, particularly in terms of MDRO, as well as the clinical and microbiological elements that may be taken into account in the discussion of empirical antibiotic therapy for patients managed for ventilator-associated pneumonia.
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页数:17
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