Treatment of hospital-acquired pneumonia
Winthrop University Hospital, Mineola, NY, USA.The Lancet Infectious Diseases (Impact Factor: 22.43). 10/2011; 11(10):728; author reply 731-2. DOI: 10.1016/S1473-3099(11)70260-2
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ABSTRACT: Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure. Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections. New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia. Antimicrobials remain the mainstay of causative severe pneumonia treatment and the optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties. Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia; however, their extensive clinical application is limited by the need for well trained physicians and adequate hospital centers. Despite advancements in antibiotic and life-supportive treatments, severe pneumonia remains a leading cause of intensive care unit (ICU) admission and death. Prompt and appropriate antimicrobial therapy is essential. The use of new nonconventional strategies for ARF management might be effective in more severe patients.Current opinion in pulmonary medicine 03/2012; 18(3):213-21. DOI:10.1097/MCP.0b013e328351f9bd · 2.76 Impact Factor
- American Journal of Respiratory and Critical Care Medicine 06/2012; 185(12):1261-5. DOI:10.1164/rccm.201203-0540UP · 13.00 Impact Factor
Article: Molecular diagnosis in HAP/VAP[Show abstract] [Hide abstract]
ABSTRACT: This review describes recent findings related to molecular-based methods of potential application in the diagnosis of bacterial hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP). It focuses on methods capable of providing organism identification and keys of bacterial resistance necessary in clinical and epidemiological management of patients and on their ability to provide quantitative results. Significant advances have been made in recent years in the field of molecular diagnosis of bacterial pathogens. Real-time PCR, hybridization and mass spectrometry-based platforms dominate the scene. Some of the new technologies provide high sensitivity and specificity in the identification of single or multiple pathogens or a combination of etiological identification and antimicrobial resistance determinants in Staphylococcus aureus, nonfermenter Gram-negative bacilli and Enterobacteriaceae that are often associated with the cause of bacterial HAP/VAP in the late onset of the disease. In diagnosis made directly from clinical specimens and quantification of targets for bacterial load, some of them are promising. Despite some limitations, current molecular diagnostic methods have a great potential to include bacterial targets useful in the identification of microorganisms and antimicrobial resistance, to analyze directly unprocessed samples and to obtain quantitative results in bacterial HAP/VAP, an entity of complex microbiological diagnosis due to the features of the pathogens commonly implicated.Current opinion in critical care 08/2012; 18(5):487-94. DOI:10.1097/MCC.0b013e3283577d37 · 2.62 Impact Factor
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