Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society
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Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society
Received 0
accepted 0
A. C. K. 0
M. L. M. contributed equally to this work. 0
0 es, University of Nebraska Medical Center , Omaha, NE 68198-5400 , USA
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
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Andre C. Kalil,1,a Mark L. Metersky,2,a Michael Klompas,3,4 John Muscedere,5 Daniel A. Sweeney,6 Lucy B. Palmer,7 Lena M. Napolitano,8 Naomi P. O’Grady,9
John G. Bartlett,10 Jordi Carratalà,11 Ali A. El Solh,12 Santiago Ewig,13 Paul D. Fey,14 Thomas M. File Jr,15 Marcos I. Restrepo,16 Jason A. Roberts,17,18
Grant W. Waterer,19 Peggy Cruse,20 Shandra L. Knight,20 and Jan L. Brozek21
1Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha; 2Division of Pulmonary and Critical Care Medicine, University of Connecticut
School of Medicine, Farmington; 3Brigham and Women’s Hospital and Harvard Medical School, and 4Harvard Pilgrim Health Care Institute, Boston, Massachusetts; 5Department of Medicine,
Critical Care Program, Queens University, Kingston, Ontario, Canada; 6Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego; 7Department of Medicine,
Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook; 8Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery,
University of Michigan, Ann Arbor; 9Department of Critical Care Medicine, National Institutes of Health, Bethesda, and 10Johns Hopkins University School of Medicine, Baltimore, Maryland;
11Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona,
Spain; 12Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York;
13Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany; 14Department of Pathology and Microbiology,
University of Nebraska Medical Center, Omaha; 15Summa Health System, Akron, Ohio; 16Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans
Health Care System and University of Texas Health Science Center at San Antonio; 17Burns, Trauma and Critical Care Research Centre, The University of Queensland, 18Royal Brisbane and
Women’s Hospital, Queensland, and 19School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; 20Library and Knowledge Services, National Jewish Health,
Denver, Colorado; and 21Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
EXECUTIVE SUMMARY
In this 2016 guideline, the term “hospital-acquired
pneumonia” (HAP) denotes an episode of pneumonia not associated
with mechanical ventilation. Thus, patients with HAP and
ventilator-associated pneumonia (VAP) belong to 2 distinct
groups. The major differences between this guideline and
the 2005 version [
1
] include the following: the use of the
Grading of Recommendations Assessment, Development
and Evaluation (GRADE) methodology for the evaluation of
all available evidence (Table 1) [
2
]; the removal of the concept
of healthcare-associated pneumonia (HCAP); and the
recommendation that each hospital generate antibiograms to guide
healthcare professionals with respect to the optimal choice of
antibiotics. In an effort to minimize patient harm and
exposure to unnecessary antibiotics and reduce the development of
antibiotic resistance, we recommend that the antibiogram
data be utilized to decrease the unnecessary use of dual
gram-negative and empiric methicillin-resistant
Staphylococcus aureus (MRSA) antibiotic treatment. We also recommend
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