Ventilator Ventilator-Associated Associated Pneumonia Pneumonia ...

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Initial Empirical Therapy for VAPVAP with no risk factorsfor MDR pathogensCeftriaxoneorLevofloxacin, moxifloxacin orciprofloxacinorAmpicillin/sulbactamorEtrapenemVAP with risk factorsfor MDR pathogensAntipseudomonal cephalosporin (cefepime,ceftazidime)orAntipseudomonal carbepenem (imipenemor meropenem)orβ-lactam/β-lactamase inhibitor (piperacillintazobactam)plusAntipseudomonal fluroquinolone(ciprofloxacin or levofloxacin)orAminoglycoside (amikacin, gentamicin ortobramyicin)plusLinezolid or vancomycin (if risk factors forMRSA are present)Joseph NM et al. Eur J Int Med 2010; 21: 360-368
Short course vs. Prolonged Antibiotic TherapyOutcome/ subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size28-day mortality 2 431 Odds Ratio(M-H, Random, 95% CI)Recurrence of pneumonia 3 508 Odds Ratio(M-H, Random, 95% CI)28-d antibiotic-free days 2 431 Mean Difference(IV, Random, 95% CI)ITU mortality 2 107 Odds Ratio(M-H, Random, 95% CI)Non-res. of pneumonia 1 77 Odds Ratio(M-H, Fixed. 95% CI)1.08 (0.66, 1.76)1.37 (0.87, 2.17)4.02 (2.26, 5.78)0.85 (0.37, 1.91)0.89 (0.49, 7.40)In-hospital mortality 1 401 Odds Ratio1.09 (0.71, 1.67)(M-H, Fixed, 95% CI)Recurrence - multi-resistantorganism1 110 Odds Ratio(M-H, Fixed. 95% CI)0.44 (0.21, 0.95)Duration of ITU stay 2 431 Mean Difference(IV, Random, 95% CI)Duration of hospital stay 1 30 Mean Difference(IV, Fixed, 95% CI)Duration of mech. ventilation 2 107 Mean Difference(IV, Random, 95% CI)28-day mechanical ventilationfreedays2 431 Mean Difference(IV, Random, 95% CI)Mortality-associated with VAP 1 77 Mean Difference(IV, Fixed, 95% CI)-0.01 (- 2.30, 2.27)-1.0 (-4.11, 2.11)-0.01 (-0.57, 0.55)0.47 (-0.97, 1.92)1.0 (-8.85, 10.95)Pugh R et al. Cochrane Database of Systematic Reviews 2012, Issue 2
Page 4: VAP Rates in the USA10.03000Mean VA
Page 8 and 9: Diagnostic Accuracy of CPIS: A Meta
Page 10 and 11: First AuthorYearSensitivity95% CITe
Page 12 and 13: Diagnosing VAP in Critically Ill Pa
Page 14: Prognostic Value in VAP1.00.8Sensit
Page 17 and 18: Quantitative vs. qualitative cultur
Page 19 and 20: Common Causes of VAP - Bronchoscopi
Page 21 and 22: Risk Factors for MDR Pathogens Anti
Page 23 and 24: 10093.3908076.5Mortality (%)7060504
Page 25 and 26: 1.00.8Mild riskSurvival0.60.4High r
Page 27: The VAP PIRO ScorePIROcomorbidities
Page 31 and 32: Screened patients after daily round
Page 33 and 34: 1.00.9No treatmentSurvival0.80.70.6
Page 35 and 36: Pharmacologic-based Strategies for
Page 37 and 38: 186 citations14 potentiallyeligible
Page 39: Specific Quality improvement interv

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