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How Should We Treat Hospital-Acquired and Ventilator-Associated Pneumonia Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae?
| Content Provider | Scilit |
|---|---|
| Author | Timsit, Jean-François Pilmis, Benoit Zahar, Jean-Ralph |
| Copyright Year | 2017 |
| Description | Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) represent a growing problem. Indeed, ESBL-PE is endemic in many countries, and 5 to 25% of intensive care unit (ICU) patients are ESBL-PE carrier on ICU admission. ESBL-PE HAP/VAP is associated with a higher mortality than HAP/VAP due to susceptible Enterobacteriaceae because the resistance profile decreases the adequacy rate of empiric therapy. ESBL-PE should be considered in the empirical treatment in case of the high burden of ESBL-PE in the unit, in the case of previous ESBL-PE colonization, when the HAP/VAP occurs late, and in patients with shock. A negative active systematic surveillance culture on rectal swab reduced the risk of ESBL-PE VAP to less than 1%. Rapid diagnostic tests are now able to confirm the presence of ESBL-PE in VAP within 24 hours; new molecular methods will provide results within few hours.Adequate treatment usually required carbapenems. The alternative β-lactams such as β-lactams/β-lactamases inhibitor combinations could be proposed as a step-down therapy according to the antibiotic susceptibility result. Optimization of pharmacokinetics requires high dosage and continuous or prolonged infusions for β-lactams. When the patient is stabilized, a therapy of duration 7 to 8 days is recommended. |
| Related Links | http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0037-1603112.pdf |
| Ending Page | 300 |
| Page Count | 14 |
| Starting Page | 287 |
| ISSN | 10693424 |
| e-ISSN | 10989048 |
| DOI | 10.1055/s-0037-1603112 |
| Journal | Seminars in Respiratory and Critical Care Medicine |
| Issue Number | 03 |
| Volume Number | 38 |
| Language | English |
| Publisher | Georg Thieme Verlag KG |
| Publisher Date | 2017-06-04 |
| Access Restriction | Open |
| Subject Keyword | Journal: Seminars in Respiratory and Critical Care Medicine Infectious Diseases Extended Spectrum Β-lactamases Ventilator-associated Pneumonia |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine Critical Care and Intensive Care Medicine |
