Naslov
Surveillance of the ventilator associated pneumonia

Autori
Bruno Baršić

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, pregledni

Izvornik
Fifth Congress of the international federation of infection control, Abstract Book / Kalenić, Smilja - Zagreb, 2004, 44-45

Skup
Fifth Congress of the international federation of infection control

Mjesto i datum
Poreč, Hrvatska, 09.10.2004. - 12.10.2004

Vrsta sudjelovanja
Ostalo

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
VAP; surveillance

Sažetak
Ventilator associated pneumonia (VAP) is a serious nosocomial infection which significantly influence patients' outcome in ICUs, increasing mortality and length-of – stay. The first step in the control of VAP is prompt and correct diagnosis which is not so easy task. X-ray of the chest is mandatory for the correct diagnosis. However, new onset infiltrates (shadows) on x-ray are common in ICU patients and can be associated with athelectases, haemorrhage, drug reactions (allergic pneumonitis), cardiac failure etc. Therefore persistent or progressing infiltrate could be sign of pneumonia. Daily follow up of patients noticing changes in the amount and appearance of tracheal secretions are of paramount importance. Appearance of purulent secretion necessitates gram stain and culture of bronchial secretion. Invasive methods for secret sampling probably are not better than non-invasive sampling of tracheal aspirate or mini-BAL . Quantitative analysis of positive specimens are helpful. The most commonly used are CDC diagnostic criteria: Pneumonia is defined separately from other infections of the lower respiratory tract. The criteria for pneumonia involve various combinations of clinical, radiographic and laboratory evidence of infection. They have to meet one of the following criteria: 1. Rales or dullness to percussion on physical examination of chest and any of the following:  New onset of purulent sputum or change in character of sputum  Organism isolated from blood culture  Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing or biopsy 2. Chest radiographic examination shows new or progressive infiltrate, consolidation, cavitation, or pleural effusion and any of the following:  New onset of purulent sputum or change in character of sputum  Organism isolated from blood culture  Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing or biopsy  Isolation of virus or detection of viral antigen in respiratory secretions  Diagnostic single antibody titre (IgM) or fourfold increase in paired serum samples (IgG) for pathogen.  Histopatologic evidence of pneumonia However, these criteria are often modified in number of surveillance studies and their use leads to increased and unnecessary prescription of antibiotics. Antimicrobial therapy must be given after the initial evaluation of patient with suspected pneumonia if patient is hypotensive, if signs of multiorgan dysfunction syndrome are present, if fighting aspirator and if there is rapid deterioration in pulmonary function.. In such cases wide antibiotic coverage must be applied but modified if gram stain was positive. If patient is stable and pneumonia is only suspected therapy could be postponed until next day. Close follow up of patients in whom antibiotic therapy was started enables earlier withdrawal of treatment.

Izvorni jezik
Engleski

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