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July/August 2016
Updated Guideline on Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia Now Available
An updated guideline on hospital-acquired pneumonia and ventilator-associated pneumonia developed by IDSA and American Thoracic Society (ATS), has been published in Clinical Infectious Diseases. According to the guideline, both types of pneumonia – which account for 20 to 25 percent of hospital-acquired infections – should be treated with shorter courses of antibiotics than they typically are. The recommendation of seven or fewer days of antibiotics for most of these infections reflects a change from previous guidelines to ensure safe and effective treatment while limiting the development of antibiotic resistance.
The new guideline also recommends that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally as well as which antibiotics effectively treat them. When possible, the antibiogram should be specific to the hospital's intensive care unit patients, according to the guideline. Antibiograms should be updated regularly, and the most appropriate frequency should be determined by the institution, the guidelines note.
Published in 2005, the previous guideline recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection. The 2016 guidelines recommend seven days or fewer for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy; in addition this can reduce antibiotic-related side effects, the risk of Clostridium difficile, antibiotic resistance, and costs. In some cases, such as when a patient doesn't improve or worsens, longer treatment may be necessary.
The guidelines panel featured experts from around the globe including infectious disease, pulmonary and critical care specialists, surgeons, pharmacologists, microbiologists, professional librarians and methodologists. In addition to Andre Kalil, MD, MPH, FIDSA and Mark Metersky, MD, (Co-Chairs), the guidelines panel includes: Michael Klompas, MD, FIDSA; John Muscedere; Daniel A. Sweeney, MD; Lucy B. Palmer; Lena M. Napolitano, MD; Naomi P. O'Grady, MD, FIDSA; John G. Bartlett, MD, FIDSA; Jordi Carratalà; Ali A. El Solh; Santiago Ewig; Paul D. Fey, PhD; Thomas M. File, Jr., MD, FIDSA; Marcos I. Restrepo; Jason A. Roberts; Grant W. Waterer; Peggy Cruse; Shandra Knight and Jan L. Brozek.

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