Empiric therapy for pneumonia in the surgical intensive care unit

Timothy Fabian

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Empiric therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi- recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society. (C) 2000 by Excerpta Medica, Inc.

Original languageEnglish (US)
Pages (from-to)18-23
Number of pages6
JournalAmerican Journal of Surgery
Volume179
Issue number2 SUPPL. 1
DOIs
StatePublished - Jan 1 2000

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Ventilator-Associated Pneumonia
Critical Care
Intensive Care Units
Pneumonia
Cross Infection
Consciousness Disorders
Anti-Bacterial Agents
Mechanical Ventilators
Malnutrition
Pseudomonas aeruginosa
Chronic Obstructive Pulmonary Disease
Staphylococcus aureus
Diabetes Mellitus
Therapeutics
Hot Temperature
Clinical Trials
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Empiric therapy for pneumonia in the surgical intensive care unit. / Fabian, Timothy.

In: American Journal of Surgery, Vol. 179, No. 2 SUPPL. 1, 01.01.2000, p. 18-23.

Research output: Contribution to journalArticle

Fabian, Timothy. / Empiric therapy for pneumonia in the surgical intensive care unit. In: American Journal of Surgery. 2000 ; Vol. 179, No. 2 SUPPL. 1. pp. 18-23.
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