Hospital-acquired pneumonia response to therapy

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]

Overview

Methicillin-resistant staphylococcus aureus is a common isolate in the patients with Hospital-acquired pneumonia. The treatment options commonly used are vancomycin, linezolid, and clindamycin. Linezolid may be preferred in patients with renal insufficiency as the nephrotoxicity with Linezolid is less compared to vancomycin. Additionally, in patients with vancomycin MIC ≥ 2mcg/mL linezolid is preferred. Linezolid resistance and failure are rare.

Major points and Recommendations for initial antibiotic therapy in adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia (DONOT EDIT)

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Major Points and Recommendations for Assessing Response to Therapy A serial assessment of clinical parameters should be used to define the response to initial empiric therapy (Level II) (193, 208). Modifications of empiric therapy should be made on the basis of this information, in conjunction with microbiologic data (Level III). Clinical improvement usually takes 48–72 hours, and thus therapy should not be changed during this time unless there is rapid clinical decline (Level III). Nonresponse to therapy is usually evident by Day 3, using an assessment of clinical parameters (Level II) (193, 208). The responding patient should have de-escalation of antibiotics, narrowing therapy to the most focused regimen possible on the basis of culture data (Level II) (205). The nonresponding patient should be evaluated for noninfectious mimics of pneumonia, unsuspected or drug-resistant organisms, extrapulmonary sites of infection, and complications of pneumonia and its therapy. Diagnostic testing should be directed to whichever of these causes is likely (Level III)

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For Level of evidence and classes click here.