Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, August 1, 2016

IDSA Guidelines 2016: HAP, VAP

PulmCCM - Jul 30, 2016
..."In the most recent update, however, HCAP has been scrapped – at least for now. A meta-analysis of 24 studies including more than 20,000 patients found that HCAP was associated with MDROs [e.g. MRSA, pseudomonas], however, the aforementioned HCAP risk factors were neither sensitive nor specific to identify at-risk patients. The poor clinical outcome noted with HCAP patients was felt to be related more strongly with age and comorbidities rather than MDROs per se. Further, there was a large publication bias suspected. The panel unanimously decided that HCAP should not be included in the HAP & VAP guidelines.
However, as a separate entity, HCAP – or some modification thereof – may be included in a forthcoming revision of the community-acquired pneumonia [CAP] guidelines...
While the current guidelines discuss a number of issues germane to HAP and VAP including: microbiological evaluation, ventilator-associated tracheobronchitis, the use of biomarkers and clinical prediction scores, inhaled antibiotics, etc. this post will focus on standard, empiric therapy as this is a common clinical quandary [see figure 1]..:"