December 30, 2010 at 7:41 pm #2960HarrisonKeymaster2 pts
In this article, there’s lots of predicting, risk stratification…but nothing about the fact that these infections are bacterial biofilms; let alone carefully diagnosing them or properly treating them. Experts agree that these infections are polymicrobial, so how can cultures be the right testing approach? This is one of the many limitations with these “new” guidelines.
Compare this with the Russian abstract – which may or may not employ an understanding of chronic bacterial biofilm infections. It is also notable that neither abstract mentions how biofilms play a key role in antibiotic resistance; let alone their contribution to chronicity.
People, these are patients that need to be diagnosed with infections! This disconnect leaves even MORE patients to get sick!
Clin Infect Dis. 2010 Aug 1;51 Suppl 1:S48-53.
TREATMENT GUIDELINES AND OUTCOMES OF HOSPITAL-ACQUIRED AND VENTILATOR-ASSOCIATED PNEUMONIA.
Torres A, Ferrer M, Badia JR.
Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
Hospital-acquired pneumonia is the second most frequent nosocomial infection and the first in terms of morbidity, mortality, and cost. In recent years, international societies and, most recently, the American Thoracic Society jointly with the Infectious Disease Society of America, have developed guidelines for the of hospital-acquired pneumonia, health care-associated pneumonia, and ventilator-associated pneumonia.
These guidelines include recommendations for , initial and definitive antibiotic treatment, and prevention. The of these guidelines is important because it confirms that they can be used in clinical practice, as quality indicators, and as a standard of care. Several processes can be validated and are included in the guidelines, such as the accuracy of the according to stratification criteria and the impact of guidelines on outcomes, including length of hospital and intensive care unit stay, duration of mechanical ventilation, complications, and in-hospital and 30-day mortality.
Clinical studies have shown that the accuracy of microorganisms according to risk stratification is reliable (approximately 80% and approximately 90%). Three studies suggest that the implementation of guidelines, with a special emphasis on antibiotic treatment, improves several parameters of outcome. Only one study, using a before-and-after design, showed a decrease in 14-day mortality after guidelines implementation.
A key issue for these studies is to modify recommendations according to local patterns of microbiology and drug resistance. In summary, implementation of guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia decreases the rate of initial inappropriate antibiotic treatment and decreased 14-day mortality in a study. More clinical studies to validate the influence of guidelines on outcome are warranted.
PMID: 20597672 [PubMed – indexed for MEDLINE]
COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS: APPROACHES TO ANTIBACTERIAL THERAPY IN THE CONTEXT OF CURRENT CLINICAL GUIDELINES
[Article in Russian]
Conciliatory guidelines for management of patients with either disease/abnormality have recently become an integral part of medical practice. The popularity of the guidelines is likely to owe to the fact that they are a more or less successful synthesis of abundant information within one document, by giving a physician detailed many-year and many-decade clinical and scientific experience. Since their publication, they become a peculiar standard of medical care delivery.
The main benefit of such guidelines should be seen in the diagnosis and treatment standardization (without a physician’s losing his/her reasonable autonomy in each individual case) that makes it possible to optimize a diagnostic process, to apply more effective therapeutic approaches, and to use less health care resources. By taking into account the drastically changing epidemiology of resistance of the causative agents of respiratory tract infection, the emergence of new antibiotics, and the rethinking of conventional diagnostic and therapeutic approaches, there is an apparent need for periodic revision and modification of such guidelines.
In this regard, of particular interest are the conciliatory guidelines of the Russian Respiratory Society and Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy, which were published in 2010.
PMID: 20873237 [PubMed – indexed for MEDLINE]
December 31, 2010 at 3:07 am #3431HarrisonKeymaster2 pts
I found the time to locate the Russian article and it provides some interesting insights into this topic.
Here is an excerpt:
“...The limitations of routine susceptibility tests were also included in Mark Wilcoxs presentation on coagulase-negative staphylococcal infections, where planktonic organisms in biofilms can compromise the reliability of in vitro tests. In similar vein, Andrei Dekhnich, in a wide-ranging review of chronic infections, noted the potential for b-lactamases to accumulate in biofilms and so inhibit antibiotic activity...”
Also, this closing excerpt suggests the importance of using molecular diagnostics, then immediately prescribing the correct antidote:
“…The importance of using current agents effectively in critical care patients was reviewed by Robert Masterton, who stressed how increased doses and infusion times in serious Gram-negative infections could minimize resistance as well as improve clinical responses…”
To not do both (diagnose and treat properly), the clinician sets up the patient for further infection, suffering and disease.
The PDF is attached.
J. Antimicrob. Chemother.-2007-Davey-1193-4.pdf
January 8, 2011 at 11:47 am #2961arielmedicoMember
Biofilm formation is under prokaryotic life cycle and it is an important factor to understand the survival mechanism in diverse environments. Researchers are still discussing on both the key factors.
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