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The U.S. Food and Drug Administration today approved a new indication for the previously FDA-approved drug, Zerbaxa (ceftolozane and tazobactam) for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in patients 18 years and older.
What is ventilator-associated pneumonia (VAP)?
Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 h after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside examination, radiographic examination, and microbiologic analysis of respiratory secretions.
What is the most common cause of ventilator-associated pneumonia?
The most common cause of ventilator-associated pneumonia is microaspiration of bacteria that colonize the oropharynx and upper airways in seriously ill patients. Endotracheal intubation is the major risk factor for ventilator-associated pneumonia.
Which sampling techniques are used in the diagnosis of ventilator-associated pneumonia?
Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia. Am. J. Respir. Crit. Care Med.152:1982-1991. [PubMed] [Google Scholar] 163. Pugin, J., R. Auckenthaler, D. P. Lew, and P. M. Suter.1991. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia.
Are probiotics effective in the prevention of ventilator-associated pneumonia?
Probiotics may be an attractive intervention in the prevention of ventilator-associated pneumonia in adult hospitalized patients. However, the certainty of the evidence on its cost-effectiveness is very low.
What antibiotics treat ventilator pneumonia?
For patients with early-onset VAP and no risk factors for multidrug-resistant (MDR) pathogens, currently recommended initial empiric antibiotics include 1 of the following options: Ceftriaxone. Fluoroquinolones. Ampicillin-sulbactam.
What is the drug of choice for hospital acquired pneumonia?
A carbapenem or ampicillin/sulbactam should be used in treating Acinetobacter HAP/VAP. If there is resistance to these agents, inhaled and intravenous colistin should be substituted. The guidelines recommend against the use of tigecycline in the treatment of Acinetobacter VAP.
What is ventilator acquired pneumonia?
Related Pages. Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient's mouth or nose, or through a hole in the front of the neck.
How is ventilator pneumonia treated?
Generally, a week of antibiotic therapy is sufficient for the treatment of VAP. In a double-blind clinical trial conducted in 51 French intensive care units or ICUs that included 401 patients with VAP, patients were randomized to 8 or 15 days of antibiotic therapy.
How can ventilator associated pneumonia be reduced?
This article reviews the top five evidence-based nursing practices for reducing VAP risk in critically ill adults.Minimize ventilator exposure. ... Provide excellent oral hygiene care. ... Coordinate care for subglottic suctioning. ... Maintain optimal positioning and encourage mobility. ... Ensure adequate staffing.
How do you get ventilator acquired pneumonia?
The most common cause of ventilator-associated pneumonia is microaspiration of bacteria that colonize the oropharynx and upper airways in seriously ill patients.
Is ventilator-associated pneumonia common?
Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria.
How to prevent ventilator pneumonia?
There are a number of measures that can help prevent ventilator-associated pneumonia. Semiupright or upright positioning reduces risk of aspiration and pneumonia compared with recumbent positioning and is the simplest and most effective preventive method.
What is the most common pathogen in ventilator-associated pneumonia?
The most common pathogens are gram-negative bacilli and Staphylococcus aureus; antibiotic-resistant organisms are an important concern. In ventilated patients, pneumonia usually manifests as fever, increase in white blood cell count, worsening oxygenation, and increased tracheal secretions that may be purulent. Diagnosis is suspected on the basis of clinical presentation and chest x-ray and is sometimes confirmed by a positive blood culture for the same pathogen found in respiratory secretions or bronchoscopic sampling of the lower respiratory tract with quantitative Gram stain and cultures. Treatment is with antibiotics. Overall prognosis is poor, due in part to comorbidities.
What is the risk of pneumonia in ventilators?
Endotracheal intubation is the major risk factor for ventilator-associated pneumonia. Endotracheal intubation breaches airway defenses, impairs cough and mucociliary clearance, and facilitates microaspiration of bacteria-laden secretions that pool above the inflated endotracheal tube cuff.
What are the most important pathogens in antibiotic resistance?
In general, the most important pathogens are Pseudomonas aeruginosa, methicillin-sensitiv e Staphylococcus aureus, and methicillin-resistant S. aureus (MRSA).
What is a noninvasive ventilation?
Noninvasive ventilation using continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) prevents the breach in airway defense that occurs with endotracheal intubation and eliminates the need for intubation in some patients.
Why is bronchoscopic sampling important?
Bronchoscopic sampling of lower airway secretions for quantitative culture yields more reliable specimens that can differentiate colonization from infection. Information gained from bronchoscopic sampling reduces antibiotic use and assists in switching from broader to narrower antibiotic coverage.
What are the risk factors for VAP?
Other risk factors for antibiotic-resistant organisms specific to VAP include. Septic shock at time of VAP. Acute respiratory distress syndrome (ARDS) preceding VAP. Hospitalization for ≥ 5 days prior to the occurrence of VAP.
What is the FDA approved drug for HABP?
The U.S. Food and Drug Administration today approved a new indication for the previously FDA-approved drug, Zerbaxa (ceftolozane and tazobactam) for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in patients 18 years and older.
What is the FDA?
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices.
What causes HABP in hospitals?
HABP/VABP occur in patients in hospitals or other health care facilities and can be caused by a variety of bacteria. According to data from the U.S. Centers for Disease Control and Prevention, HABP and VABP are currently the second most common type of hospital-acquired infection in the United States, and are a significant issue in patients in ...
Can you take Zerbaxa with piperacillin?
Zerbaxa should not be used in patients with known serious hypersensitivity to components of Zerbaxa, as well as hypersensitivity to piperacillin/tazobactam or other members of the beta lactam class of antibacterial drugs.
Abbreviations
Ventilator-associated pneumonia (VAP) continues to be the most common nosocomial infection in the ICU, making up almost one third of the total nosocomial infections.
TREATMENT
Prompt initiation of antibiotic therapy is a cornerstone of treatment of VAP. Even relatively short delays in administering adequate antibiotic therapy are associated with an increased mortality rate.
SUMMARY
There are many aspects of the diagnosis and treatment of VAP that remain to be clarified. However, a systematically applied strategy that addresses early intervention with broad-spectrum antibiotics based on the risks for MDR organisms, and which is appropriate to the local antibiogram, can improve outcomes.
REFERENCES
Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.