related to age and co morbidities than the presence of the multiresistant organism per se. So the panel unanimously decided not include HCAP in the HAP/VAP guideline update this year.
Use of antibiogram: The guideline also urges that every hospital and ICU has their own antibiogram tailored to their HAP/VAP population if possible. This was based on their evaluation of some observational studies one of them was done with 229 patients at 4 different institutions which showed the variation in pathogens, their frequency and their resistance patterns .Another study found that the resistance pattern found in general hospital antibiogram reflected in the ICU acquired infections as well. Based on all of these findings, the guidelines recommend on …show more content…
They also mention that these trials excluded patients who have resistant strains and other comorbidies. But their recommendation is to use 2 different antipseudomonal agents from different classes, if more than 10% of the bacterial isolates are resistant to the antipseudomonal antibiotic which was chosen originally. This double coverage is recommended in patients with structural lung disease or if the prevalence of antibiotic resistance is unknown. Aminoglycosides and colistin is not recommended but could be used IV or via inhalation if the isolate susceptible to only those agents. Once the pseudomonas isolate is known they recommend appropriate …show more content…
The quality of evidence was not very strong since most of the studies in the metanalysis were observational study with a risk of bias due to unbalanced influence of 1 particular study. So the panel carefully evaluated the advantages of PK/PD dosing like decreased mortality, length of hospital stay and increased the cure rate against potential downsides like costs, requirement to train professionals and lab expenses to measure blood concentration and acquiring and updating the software required for all of this .They decided that PK/PD based will increase clinical cure rate and this will lead to shorter courses of antibiotic, which would relate to less antibiotic toxicity and less resistance. Moreover potential benefits of such dosing is important in these population than the inconveniences and cost associated with it .Distribution of many antibiotics is severely altered by pathophysiological changes in a patient who is critically ill and it is important that we follow PK/PD to improve cure rates .The recommendation of using PK/PD parameters to guide treatment than following manufacture’s dosing guidelines is a very weak recommendation with low quality
Use of antibiogram: The guideline also urges that every hospital and ICU has their own antibiogram tailored to their HAP/VAP population if possible. This was based on their evaluation of some observational studies one of them was done with 229 patients at 4 different institutions which showed the variation in pathogens, their frequency and their resistance patterns .Another study found that the resistance pattern found in general hospital antibiogram reflected in the ICU acquired infections as well. Based on all of these findings, the guidelines recommend on …show more content…
They also mention that these trials excluded patients who have resistant strains and other comorbidies. But their recommendation is to use 2 different antipseudomonal agents from different classes, if more than 10% of the bacterial isolates are resistant to the antipseudomonal antibiotic which was chosen originally. This double coverage is recommended in patients with structural lung disease or if the prevalence of antibiotic resistance is unknown. Aminoglycosides and colistin is not recommended but could be used IV or via inhalation if the isolate susceptible to only those agents. Once the pseudomonas isolate is known they recommend appropriate …show more content…
The quality of evidence was not very strong since most of the studies in the metanalysis were observational study with a risk of bias due to unbalanced influence of 1 particular study. So the panel carefully evaluated the advantages of PK/PD dosing like decreased mortality, length of hospital stay and increased the cure rate against potential downsides like costs, requirement to train professionals and lab expenses to measure blood concentration and acquiring and updating the software required for all of this .They decided that PK/PD based will increase clinical cure rate and this will lead to shorter courses of antibiotic, which would relate to less antibiotic toxicity and less resistance. Moreover potential benefits of such dosing is important in these population than the inconveniences and cost associated with it .Distribution of many antibiotics is severely altered by pathophysiological changes in a patient who is critically ill and it is important that we follow PK/PD to improve cure rates .The recommendation of using PK/PD parameters to guide treatment than following manufacture’s dosing guidelines is a very weak recommendation with low quality