Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated
      Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of
      America and the American Thoracic Society

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Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

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Most cited references 5

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Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.

Roger Nation, Jian Li, Otto Cars … (2015)

In the face of diminishing therapeutic options for the treatment of infections caused by multidrug-resistant, Gram-negative bacteria, clinicians are increasingly using colistin and polymyxin B. These antibiotics became available clinically in the 1950s, when understanding of antimicrobial pharmacology and regulatory requirements for approval of drugs was substantially less than today. At the 1st International Conference on Polymyxins in Prato, Italy, 2013, participants discussed a set of key objectives that were developed to explore the factors affecting the safe and effective use of polymyxins, identify the gaps in knowledge, and set priorities for future research. Participants identified several factors that affect the optimum use of polymyxins, including: confusion caused by several different conventions used to describe doses of colistin; an absence of appropriate pharmacopoeial standards for polymyxins; outdated and diverse product information; and uncertainties about susceptibility testing and breakpoints. High-priority areas for research included: better definition of the effectiveness of polymyxin-based combination therapy compared with monotherapy via well designed, randomised controlled trials; examination of the relative merits of colistin versus polymyxin B for various types of infection; investigation of pharmacokinetics in special patient populations; and definition of the role of nebulised polymyxins alone or in combination with intravenous polymyxins for the treatment of pneumonia. The key areas identified provide a roadmap for action regarding the continued use of polymyxins, and are intended to help with the effective and safe use of these important, last-line antibiotics.

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Author and article information

Journal

Title: Clinical Infectious Diseases

Publisher: Oxford University Press (OUP)

ISSN (Electronic): 1537-6591

ISSN (Print): 1058-4838

Publication date Created: September 01 2016

Publication date Created: August 08 2016

Publication date Other: September 01 2016

Publication date (Print): September 01 2016

Publication date (Electronic): August 08 2016

Volume: 63

Issue: 5

Pages: 575-582

Affiliations

[1 ] Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha

[2 ] Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington

[3 ] Brigham and Women's Hospital and Harvard Medical School

[4 ] Harvard Pilgrim Health Care Institute, Boston, Massachusetts

[5 ] Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada

[6 ] Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego

[7 ] Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook

[8 ] Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor

[9 ] Department of Critical Care Medicine, National Institutes of Health, Bethesda

[10 ] Johns Hopkins University School of Medicine, Baltimore, Maryland

[11 ] Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain

[12 ] Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York

[13 ] Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany

[14 ] Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha

[15 ] Summa Health System, Akron, Ohio

[16 ] Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio

[17 ] Burns, Trauma and Critical Care Research Centre, The University of Queensland

[18 ] Royal Brisbane and Women's Hospital, Queensland

[19 ] School of Medicine and Pharmacology, University of Western Australia, Perth, Australia

[20 ] Library and Knowledge Services, National Jewish Health, Denver, Colorado

[21 ] Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Article

DOI: 10.1093/cid/ciw504

PMC ID: 4981763

PubMed ID: 27521441

SO-VID: a6b779ea-24f1-4f72-b907-2a68e2152008

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Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

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Abstract

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Pneumonia, sex, and the environment

Most cited references 5

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.

Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.

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Cited by 125

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