Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)—which account for 20% to 25% of hospital-acquired infections—should be treated with shorter courses of antibiotics, according to new guidelines released by the Infectious Diseases Society of America and American Thoracic Society (Clin Infect Dis 2016 Jul 13.
The new guidelines recommend seven days or less of antibiotics for most of these infections, which reflects a change from previous guidelines, which had recommended longer courses. The guidelines said the shorter courses ensure safe and effective treatment while limiting the development of antibiotic resistance.
The new guidelines also recommend that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia locally as well as which antibiotics effectively treat them. When possible, the antibiogram should be specific to the hospital’s ICU patients, according to the guidelines. Antibiograms should be updated regularly, and the most appropriate frequency should be determined by the institution, the guidelines noted.
“Once clinicians are updated regularly on what bugs are causing VAP and HAP in their hospitals as well as their sensitivities to specific antibiotics, they can choose the most effective treatment,” said Andre C. Kalil, MD, MPH, a professor of medicine in the Division of Infectious Diseases and the director of the transplant infectious diseases program at the University of Nebraska Medical Center, in Omaha. “This helps individualize care, ensuring patients will be treated with the correct antibiotic as soon as possible.”
Published in 2005, the previous guidelines recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection. The 2016 guidelines recommend seven days or less for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy; in addition, this can reduce antibiotic-related side effects, the risk for Clostridium difficile, antibiotic resistance and costs, said Dr. Kalil, who also is a co-chair of the panel. In some cases, such as when a patient doesn’t improve or worsens, longer treatment may be necessary.
One of every 10 patients on a ventilator gets VAP, which is fatal about 13% of the time. VAP also increases:
• the amount of time patients remain on a ventilator (7.6-11.5 days on average); and
• the hospital length of stay (11.5-13.1 days on average).
While HAP typically is a less severe infection, half of patients have serious complications, including respiratory failure, pleural effusion, septic shock and kidney failure.
The guidelines panel featured experts from around the globe including infectious disease, pulmonary and critical care specialists; surgeons; pharmacologists; microbiologists; professional librarians; and methodologists.