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An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines

Authors Awad LS, Abdallah DI, Mugharbil AM, Jisr TH, Droubi NS, El-Rajab NA, Moghnieh RA

Received 7 July 2017

Accepted for publication 29 August 2017

Published 22 December 2017 Volume 2018:11 Pages 17—28

DOI https://doi.org/10.2147/IDR.S145827

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Lyn S Awad,1,* Dania I Abdallah,1,* Anas M Mugharbil,2,3 Tamima H Jisr,2,4 Nabila S Droubi,1 Nabila A El-Rajab,5 Rima A Moghnieh2,6,7

1Pharmacy Department, Makassed General Hospital, 2Faculty of Medicine, Beirut Arab University, 3Department of Internal Medicine, Division of Hematology-Oncology, 4Department of Laboratory Medicine, 5Department of Internal Medicine, 6Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, 7Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon

*These authors contributed equally to this work

Introduction: Management of ventilator-associated pneumonia (VAP), the most common infection in patients on mechanical ventilation, should be tailored to local microbiological data. The aim of this study was to determine susceptibility patterns of organisms causing VAP to develop a treatment algorithm based on these findings and evidence from the literature.
Materials and methods: This is a retrospective analysis of the microbiological etiology of VAP in the intensive care unit (ICU) of a Lebanese tertiary care hospital from July 2015 to July 2016. We reviewed the latest clinical practice guidelines on VAP and tried to adapt these recommendations to our setting.
Results:
In all, 43 patients with 61 VAP episodes were identified, and 75 bacterial isolates caused VAP. Extensively drug-resistant (XDR) Acinetobacter baumannii was the most common organism (37%), and it had occurred endemically throughout the year. Pseudomonas aeruginosa was the next most common organism (31%), and 13% were XDR. Enterobacteriaceae (15%) and Stenotrophomonas maltophilia (12%) shared similar incidences. Our algorithm was based on guidelines, in addition to trials, systematic reviews, and meta-analyses that studied the effectiveness of available antibiotics in treating VAP.
Conclusion:
Knowing that resistance can rapidly develop within a practice environment, more research is needed to identify the best strategy for the management of VAP.

Keywords: ventilator-associated pneumonia, Pseudomonas aeruginosa, Acinetobacter baumannii, local epidemiology, carbapenem-sparing strategy, guidelines

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