- 作者：Fabio Franzetti ; Massimo Antonelli ; Matteo Bassetti ; Francesco Blasi ; Martin Langer ; Francesco Scaglione ; Emanuele Nicastri ; Francesco N. Lauria ; Giampiero Carosi ; Mauro Moroni ; Giuseppe Ippolito ; the GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) Working Group on Hospital-Associated Pneum
- 关键词：Nosocomial pneumonia ; Health care-associated pneumonia ; Methicillin-resistant staphylococci
- 刊名：International Journal of Infectious Diseases
- 出版年：2010
- 出版时间：October 2010
- 年：2010
- 卷：14
- 期：Supplement 4
- 页码：S55-S65
- 全文大小：347 K
Summary
BackgroundHospital-associated pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. Many aspects of the treatment of HAP caused by multi-resistant Gram-positive microorganisms have been extensively studied, but controversial issues remain.Controversial issues
The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group – a panel of multidisciplinary experts – was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Is combination antibiotic therapy or monotherapy more effective in the treatment of HAP? (2) What role do pharmacokinetic/pharmacodynamic antibiotic features have as a guide in the selection of treatment for HAP? (3) Is a de-escalation approach for the management of HAP effective? An analysis of the studies published up until April 2009 is presented and discussed in detail.
Methods
A systematic literature search using PubMed, MEDLINE, and EMBASE databases and the Cochrane Library was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle–Ottawa Quality Assessment Scale for case–control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence was applied.