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Hospital-acquired pneumonia and ventilator-associated pneumonia Mikio SASANO 1 1Department of Intensive Care Medicine Nakagami Hospital pp.87-100
Published Date 2019/1/1
DOI https://doi.org/10.11477/mf.3102200601
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Hospital-acquired pneumonia(HAP) and ventilator-associated pneumonia (VAP) are common and important hospital-acquired infections with high morbidity, mortality, and cost. In 2016, the Infectious Diseases Society of America and the American Thoracic Society updated the guideline for the diagnosis and management of patients with HAP and VAP. The guideline puts strong emphasis on the management of multidrug-resistant pathogens. For the diagnosis of VAP the guideline suggests noninvasive sampling (eg, endotracheal aspiration) with semiquantitative cultures, rather than invasive (eg, bronchoscopy) or noninvasive sampling with quantitative cultures. The optimal method to establish the diagnosis of VAP remains controversial. For patients with HAP/ VAP who are being treated empirically, the guideline recommends antibiotics with activity against P. aeruginosa and other gram-negative bacilli regardless of the duration of hospitalization/intubation or severity. In addition to assessing risk factors for antimicrobial resistance, the local antibiogram should be utilized to decide on the implementation of dual antimicrobial therapy against P. aeruginosa. Treatment strategies such as de-escalation of antibiotics or procalcitonin-guided therapy are not evidence-based, and are only weakly recommended in the guideline.


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電子版ISSN 2186-7852 印刷版ISSN 1883-4833 メディカル・サイエンス・インターナショナル

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