Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 22:11:17-28.
doi: 10.2147/IDR.S145827. eCollection 2018.

An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines

Lyn S Awad #  1 , Dania I Abdallah #  1 , Anas M Mugharbil  2   3 , Tamima H Jisr  2   4 , Nabila S Droubi  1 , Nabila A El-Rajab  5 , Rima A Moghnieh  2   6   7
Affiliations

An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines

Lyn S Awad et al. Infect Drug Resist. .

Abstract

Introduction: Management of ventilator-associated pneumonia (VAP), the most common infection in patients on mechanical ventilation, should be tailored to local microbiological data. The aim of this study was to determine susceptibility patterns of organisms causing VAP to develop a treatment algorithm based on these findings and evidence from the literature.

Materials and methods: This is a retrospective analysis of the microbiological etiology of VAP in the intensive care unit (ICU) of a Lebanese tertiary care hospital from July 2015 to July 2016. We reviewed the latest clinical practice guidelines on VAP and tried to adapt these recommendations to our setting.

Results: In all, 43 patients with 61 VAP episodes were identified, and 75 bacterial isolates caused VAP. Extensively drug-resistant (XDR) Acinetobacter baumannii was the most common organism (37%), and it had occurred endemically throughout the year. Pseudomonas aeruginosa was the next most common organism (31%), and 13% were XDR. Enterobacteriaceae (15%) and Stenotrophomonas maltophilia (12%) shared similar incidences. Our algorithm was based on guidelines, in addition to trials, systematic reviews, and meta-analyses that studied the effectiveness of available antibiotics in treating VAP.

Conclusion: Knowing that resistance can rapidly develop within a practice environment, more research is needed to identify the best strategy for the management of VAP.

Keywords: Acinetobacter baumannii; Pseudomonas aeruginosa; carbapenem-sparing strategy; guidelines; local epidemiology; ventilator-associated pneumonia.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Antibiotic consumption in the ICU of our facility during the study period (July 2015–July 2016) reported in DDD/100 BD. Note: x-axis, type of antimicrobial; y-axis, DDD/1000 bed days. Abbreviations: AMG, aminoglycosides; BD, bed day; CAR, carbapenems; CAZ, ceftazidime; CRO, ceftriaxone; CST, colistin; DDD, defined daily dose; FEP, cefepime; FQ, fluoroquinolones; GLY, glycopeptides (vancomycin and teicoplanin); ICU, intensive care unit; LZD, linezolid; TGC, tigecycline; TZP, piperacillin/tazobactam.
Figure 2
Figure 2
Our proposed treatment algorithm for empiric and targeted treatment of VAP. Abbreviations: A. baumannii, Acinetobacter baumannii; CAZ, ceftazidime, CRO, ceftriaxone; CST, colistin; DTA, deep tracheal aspirate; FEP, cefepime; IV, intravenous; LVX, levofloxacin; P. aeruginosa, Pseudomonas aeruginosa; S. maltophilia, Stenotrophomonas maltophilia; TMP/SMX, trimethoprim/sulfamethoxazole; TZP, piperacillin/tazobactam; VAP, ventilator-associated pneumonia; XDR, extensively drug resistant; 3GCR, third-generation cephalosporin resistant.
See this image and copyright information in PMC

References

    1. Kollef MH, Chastre J, Fagon JY, et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Crit Care Med. 2014;42(10):2178–2187. - PubMed
    1. Chaudhry D, Prajapat B. Intensive care unit bugs in India: how do they differ from the western world? J Assoc Chest Phys. 2017;5(1):10.
    1. Lee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10(9):4274–4305. - PMC - PubMed
    1. Kalil AC, Metersky ML, Klompas M, et al. 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. Clin Infect Dis. 2016;63(5):e61–e111. - PMC - PubMed
    1. WHO (World Health Organization) Introduction to Drug Utilization Research. Geneva: WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services; 2003.

LinkOut - more resources