M H Kollef

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..To assess the effect of baseline variables, including treatment, on clinical cure and survival rates in patients with Gram-positive, ventilator-associated pneumonia (VAP)...

..Antibacterial resistance is minimised by narrowing the antibacterial regimen once the pathogens and their susceptibility profiles are determined, and by employing the shortest course of therapy clinically acceptable...

..Among these wide-ranging strategies are adequate decontamination between patient contacts, antibiotic guidelines to limit unnecessary use, and use of combination antimicrobial therapy...

..Only in this way can the impact of interventions aimed at improving antibiotic use (e.g. antibiotic rotation, de-escalation therapy) be evaluated at the local level...

..Although this hypothesis is anticipated to decrease the use of ventilation-perfusion (VQ) scans and other diagnostic tests for PE, it has not been tested in a "real-world" environment...

..Careful, focused attention to this problem at the local ICU level, using a multidisciplinary approach, will have the greatest likelihood of limiting the development and dissemination of antibiotic-resistant infections...

..To evaluate the relationship between nosocomial infections and clinical outcomes following cardiac surgery, and to identify risk factors for the development of nosocomial infections in this patient population...

..These findings suggest that similar types of guidelines employing local microbiological data can be used to improve overall antibiotic utilization for the treatment of ventilator-associated pneumonia...

..To evaluate the relationship between inadequate antimicrobial treatment of infections (both community-acquired and nosocomial infections) and hospital mortality for patients requiring ICU admission...

..To determine the influence of mini-BAL culture results on subsequent changes in antibiotic therapy and patient outcomes...

..Prolonged decontamination of the aerodigestive tract with topical antimicrobials does not appear to influence outcome, and should not be routinely employed...

..To determine the influence of gender on patient outcomes and the delivery of medical care during mechanical ventilation for acute respiratory failure...

..The main goal of cycling is to allow resistance rates for specific antibiotics to decrease, or at least remain stable, when their use is periodically eliminated from the intensive care unit...

..Further study evaluating the use of antibiotic practice guidelines and strategies to reduce inadequate treatment is necessary to determine their impact on patient outcomes...

..More importantly, they should cooperate in the development of local multidisciplinary strategies aimed at the prevention of VAP and other nosocomial infections...

..To determine whether the application of continuous aspiration of subglottic secretions (CASS) is associated with a decreased incidence of ventilator-associated pneumonia (VAP)...

..To be successful, such quality improvement programs must be embraced at the institutional level. Only in this way can hospitals hope to successfully reduce their rates of VAP and sustain or improve upon those efforts over time...

..Protocols are one method for potentially reducing those delays and ensuring that medical care is administered in a more standardized and efficient manner...

..Physicians frequently prescribe respiratory treatments to hospitalized patients, but the influence of such treatments on clinical outcomes is difficult to assess...

..Studies are needed to define the optimal choice of antibiotic for pneumonias caused by this organism, and these choices will need to be balanced with the need to minimize the emergence of resistance...

..Based on these results, aggressive dosing strategies for vancomycin (eg, trough concentrations of > 15 microg/mL) may not offer any advantage over traditional dose targets (range, 5 to 15 microg/mL)...

..These data suggest that the use of standardized order sets for the management of septic shock should be routinely employed...

..To gain a better understanding of the epidemiology, microbiology, and outcomes of early-onset, culture-positive, community-acquired, healthcare-associated, and hospital-acquired bloodstream infections...

..e., antibiotic heterogeneity) can be part of a broader effort aimed at curtailing antibiotic resistance within ICUs. Such efforts should be routine, given the limited availability of new antibiotic drug classes for the foreseeable future...

..To assemble the available clinical data on the prevention of antimicrobial resistance in the intensive care unit (ICU) setting...

..Confronting the adverse impact of MRSA will require efforts that address more than the initial antibiotic prescription...

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..Accumulating evidence suggests that health-care-associated infections are distinct from those that are truly community acquired...

..This review highlights selected areas of new clinical research on VAP treatment and prevention in order to place their significance in context...

..To assemble the available clinical data for the prevention of antimicrobial resistance into practical recommendations for clinicians...

..Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation...

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..The aim of this article is to create awareness of the entity known as HCAP and to provide knowledge of its identification and initial management in the emergency department...

..This article reviews the clinical features of, diagnosis of, and therapies for MRSA pneumonia...

..Other treatment options are limited, but new prospects are being investigated. This paper reviews the epidemiology and pharmacotherapy of MRSA pneumonia...

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..Health care providers should differentiate patients with HCAP from those with CAP in order to provide more appropriate initial antimicrobial therapy...

..To examine the 30-day mortality rate among patients with Clostridium difficile-associated disease (CDAD) requiring intensive care...

..Multidrug-resistant P. aeruginosa may require treatment with less commonly used antibacterials (e.g. colistin), but newer anti-pseudomonal antibacterials are expected to be available in the near future...

..To identify predictors of in-hospital mortality among patients with bacteremia caused by Enterobacter cloacae, Enterobacter aerogenes, or Citrobacter freundii...

..The annual percentage of MRSA isolates from cases of healthcare-associated and hospital-acquired infection that were susceptible to 3 or more non- beta -lactam antibiotics increased significantly...

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..Additional studies are required to determine how the use of these specific interventions influences the occurrence and the natural history of delirium among critically ill patients...

..CONCLUSIONS: Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality...

..To assess the effect of baseline variables, including treatment, on outcome in patients with nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA)...

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..This was likely due in large part to prior VRE exposures in the rest of the hospital where these control measures were not being used...

..Clinicians should also be aware that additional blood samples may be necessary when interpreting positive blood culture results for common skin or central vein catheter contaminants...

..While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems...

..Education programs should be more widely employed for infection control in the intensive care unit setting and can lead to substantial decreases in cost and patient morbidity attributed to hospital-acquired infections...

..Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality...

..Additionally, early detection methods should be considered to reduce the potential morbidity associated with untreated DVT in this high-risk population...

..5 +/- 0.4 vs. 6.7 +/- 1.2 mm, p <.001). CONCLUSIONS: Endotracheal tube intraluminal volume loss is common among patients with acute respiratory failure requiring mechanical ventilation and increases with prolonged tracheal intubation...

..CONCLUSIONS: Linezolid is a cost-effective alternative to vancomycin for the treatment of ventilator-associated pneumonia...

..CONCLUSIONS: These data suggest that bloodstream infections due to P aeruginosa have a greater risk of hospital mortality compared to bloodstream infections due to S aureus despite adequate antibiotic treatment...

..Given the evidence supporting greater morbidity, hospital mortality, and medical care costs among patients who have VAP, the prevention of this nosocomial infection should be an important priority in the hospital setting...

..aeruginosa bloodstream infection. Inappropriate antimicrobial treatment of P. aeruginosa bloodstream infections may be minimized by increased use of combination antimicrobial treatment until susceptibility results become known...

..These infection-control policies also require the presence of a dedicated group of infection-control practitioners to provide education, collect surveillance data, and oversee the implementation of the local infection-control plan...

..imipenem-cilastatin) was not predictive of outcomes, thus suggesting that the treatment regimens were equivalent. Both levofloxacin and imipenem-cilastatin regimens were well tolerated and had similar adverse event profiles...

..Invasive strategies do not alter mortality. Invasive approaches to ventilator-associated pneumonia affect antibiotic use and prescribing...

..To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria...

..The carbapenems are active against both Gram-positive and Gram-negative pathogens, including anaerobes; resistance to carbapenems remains rare...

..Education programs may lead to a substantial decrease in medical-care costs and patient morbidity attributed to central venous catheterization when implemented as part of mandatory training...

..In conclusion, the successful implementation of this cycling protocol increased antibiotic heterogeneity over time in the study unit...

..To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system...

..In settings with high levels of antibiotic resistance, combined approaches of non-antibiotic using strategies and education programs might be most beneficial...

..To determine the relationship between packed red blood cell transfusion practice and the development of ventilator-associated pneumonia (VAP)...

..The recent emergence of vancomycin-resistant Staphylococcus aureus and the presence of a patient population co-colonized or co-infected with VRE and MRSA support the need for aggressive infection control measures in the ICU...

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