Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia. Comparative Effectiveness Review Number 136. Effective Health Care Program.

摘要

Hospital-acquired (or nosocomial) pneumonia (HAP) is the second most common hospital-acquired infection. It occurs especially in the elderly, immunocompromised patients, surgical patients, and individuals receiving enteral feeding through a nasogastric tube. The incidence rates for HAP, which can occur in all areas of hospitals, range from 5 to more than 20 per 1,000 admissions.1,2 HAP is the leading cause of hospital-acquired infection in the intensive care unit (ICU).1 Almost one-third of HAP episodes are acquired in ICUs;3 as many as 90 percent of ICU cases may be ventilator associated.3,4 In the ICU setting, HAP accounts for up to 25 percent of all infections and for more than 50 percent of the antibiotics prescribed.1 Guidelines issued in 2005 by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) described HAP and two related pneumonias, ventilator-associated pneumonia (VAP) and healthcare-associated pneumonia (HCAP).1 Briefly: ? HAP is a pneumonia that occurs 48 hours or more after admission and was not incubating at the time of admission. ? VAP is a pneumonia that presents more than 48 to 72 hours after endotracheal intubation. It is a severe type of HAP; because of the difficulty in treating it, its prognosis can be poor. ? HCAP is a pneumonia that develops in any patient who meets one or more of several criteria: had been hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; had resided in a nursing home or long-term care facility; had received recent intravenous (IV) antibiotic therapy, chemotherapy, or wound care within the 30 days preceding the current infection; or had attended a hospital or hemodialysis clinic.