Empiric Treatment in HAP/VAP: “Don’t You Want to Take a Leap of Faith?”

Antibiotics

Khalil Chaïbi¹  Jean-Ralph Zahar²  Benoît Pilmis³  Laurent Dortet⁴  Gauthier Péan de Ponfilly⁵ 

[1] Département de Réanimation Médico-Chirurgicale, AP-HP Hôpital Avicenne, Université Sorbonne Paris Nord, 93000 Bobigny, France;Infection Control Unit, AP-HP Hôpital Avicenne, Université Sorbonne Paris Nord, 93000 Bobigny, France;Institut Micalis, Unité Mixte de Recherche 1319, Université Paris-Saclay, INRAe, AgroParisTech, 92290 Châtenay Malabry, France;Service de Bactériologie-Hygiène, CHU de Bicêtre, Assistance Publique des Hôpitaux de Paris, Centre National de Référence de la Résistance aux Antibiotiques, 94270 Le Kremlin-Bicêtre, France;Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France;

关键词: antibiotic choices;    HAP;    VAP;    colonization;    antibiotic pressure;   

DOI  :  10.3390/antibiotics11030359

来源: DOAJ

【 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.

【 授权许可】

Unknown