A Narrative Review on the Approach to Antimicrobial Use in Ventilated Patients with Multidrug Resistant Organisms in Respiratory Samples-To Treat or Not to Treat? That Is the Question.
ICU
decision
multidrug resistant
treatment
ventilator associated pneumonia
ventilator associated tracheobronchitis
Journal
Antibiotics (Basel, Switzerland)
ISSN: 2079-6382
Titre abrégé: Antibiotics (Basel)
Pays: Switzerland
ID NLM: 101637404
Informations de publication
Date de publication:
27 Mar 2022
27 Mar 2022
Historique:
received:
10
03
2022
revised:
18
03
2022
accepted:
23
03
2022
entrez:
23
4
2022
pubmed:
24
4
2022
medline:
24
4
2022
Statut:
epublish
Résumé
Multidrug resistant organisms (MDRO) are commonly isolated in respiratory specimens taken from mechanically ventilated patients. The purpose of this narrative review is to discuss the approach to antimicrobial prescription in ventilated patients who have grown a new MDRO isolate in their respiratory specimen. A MEDLINE and PubMed literature search using keywords "multidrug resistant organisms", "ventilator-associated pneumonia" and "decision making", "treatment" or "strategy" was used to identify 329 references as background for this review. Lack of universally accepted diagnostic criteria for ventilator-associated pneumonia, or ventilator-associated tracheobronchitis complicates treatment decisions. Consideration of the clinical context including signs of respiratory infection or deterioration in respiratory or other organ function is essential. The higher the quality of respiratory specimens or the presence of bacteremia would suggest the MDRO is a true pathogen, rather than colonization, and warrants antimicrobial therapy. A patient with higher severity of illness has lower safety margins and may require initiation of antimicrobial therapy until an alternative diagnosis is established. A structured approach to the decision to treat with antimicrobial therapy is proposed.
Identifiants
pubmed: 35453203
pii: antibiotics11040452
doi: 10.3390/antibiotics11040452
pmc: PMC9031060
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
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