This document provides information on updated disease notification responsibilities and immunization guidelines. It lists diseases that medical facilities must notify responders about after exposure. These include bloodborne, airborne, and droplet transmitted diseases like hepatitis, HIV, influenza, meningitis and more. The document discusses prevention of diseases through travel screening, herd immunity from vaccination, and recent disease case numbers. It provides guidance on healthcare worker vaccination and testing requirements.
The document provides new guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It discusses the definitions, epidemiology, risk factors, pathogenesis, diagnosis, and initial antibiotic therapy for HAP and VAP. For diagnosis, it recommends either a clinical approach using criteria like the Clinical Pulmonary Infection Score (CPIS) or a quantitative culture approach using techniques like bronchoscopy. For initial therapy, it stratifies patients into different risk groups and provides treatment recommendations based on the severity of illness and risk of multi-drug resistant pathogens.
Integration of pharmacokinetics (PK)-pharmacodynamics (PD) data to predict th...Ahmed Ali
1. The document discusses using a PK/PD approach to predict the efficacy of repurposed antiviral drugs for COVID-19. It analyzes drugs like lopinavir/ritonavir, remdesivir, favipiravir, and hydroxychloroquine.
2. For lopinavir/ritonavir, the high protein binding restricts achievement of therapeutic drug levels in the lungs. Clinical trials showed a lack of efficacy.
3. For remdesivir, the prodrug is converted to a nucleoside metabolite with low levels in the lungs. While initial trials showed clinical improvement, more data is still needed.
Favipiravir is an antiviral drug being studied for the treatment of COVID-19. The document summarizes several studies on favipiravir including: a randomized controlled trial from China finding favipiravir led to faster viral clearance and improved chest imaging outcomes compared to lopinavir/ritonavir; observational data from Japan showing clinical improvement in most patients, especially those with mild/moderate disease; and a Russian study demonstrating improved viral clearance and fever relief with favipiravir versus standard of care. The document also reviews favipiravir's mechanism of action, potential adverse effects, and prescribing guidelines.
Treatment of hospital acquired, ventilator-associated, and healthcare-associa...Christian Wilhelm
This document discusses the treatment of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP) in adults. It emphasizes the importance of appropriate antibiotic therapy based on risk factors for multidrug-resistant pathogens. For patients at higher risk, empiric broad-spectrum multidrug therapy is recommended. Once culture results are available, therapy should be narrowed based on susceptibility. Adherence to treatment guidelines has been shown to improve outcomes in some studies, but guidelines may fail to identify some patients at risk of drug-resistant bacteria.
This document discusses hospital acquired pneumonia (HAP), ventilator associated pneumonia (VAP), and healthcare associated pneumonia (HCAP). It provides definitions for these types of pneumonia and notes there is evidence many HCAP patients are not actually at high risk for multidrug-resistant pathogens. The document reviews attributable mortality and prolonged ICU/hospital stays related to VAP. It examines diagnostic challenges and recommends the use of endotracheal aspirate cultures over more invasive sampling methods. The document provides guidance on empiric treatment, de-escalation, length of therapy, and using biomarkers to discontinue antibiotics for VAP.
This document discusses issues in selecting appropriate non-inferiority margins or "deltas" in clinical trials comparing a new drug to an active control drug. It examines challenges in setting deltas for acute bacterial meningitis and hospital-acquired pneumonia based on historical data, disease severity, and practical trial considerations. For both conditions, the magnitude of benefit from antibiotics over placebo is unclear from old studies. A smaller delta reflecting less acceptable inferiority is preferable for severe diseases, but may require impractically large trials.
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but minimized to avoid overuse. Most patients can be treated for 7-8 days, but longer courses may be needed for certain multidrug-resistant pathogens.
This document provides information on updated disease notification responsibilities and immunization guidelines. It lists diseases that medical facilities must notify responders about after exposure. These include bloodborne, airborne, and droplet transmitted diseases like hepatitis, HIV, influenza, meningitis and more. The document discusses prevention of diseases through travel screening, herd immunity from vaccination, and recent disease case numbers. It provides guidance on healthcare worker vaccination and testing requirements.
The document provides new guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It discusses the definitions, epidemiology, risk factors, pathogenesis, diagnosis, and initial antibiotic therapy for HAP and VAP. For diagnosis, it recommends either a clinical approach using criteria like the Clinical Pulmonary Infection Score (CPIS) or a quantitative culture approach using techniques like bronchoscopy. For initial therapy, it stratifies patients into different risk groups and provides treatment recommendations based on the severity of illness and risk of multi-drug resistant pathogens.
Integration of pharmacokinetics (PK)-pharmacodynamics (PD) data to predict th...Ahmed Ali
1. The document discusses using a PK/PD approach to predict the efficacy of repurposed antiviral drugs for COVID-19. It analyzes drugs like lopinavir/ritonavir, remdesivir, favipiravir, and hydroxychloroquine.
2. For lopinavir/ritonavir, the high protein binding restricts achievement of therapeutic drug levels in the lungs. Clinical trials showed a lack of efficacy.
3. For remdesivir, the prodrug is converted to a nucleoside metabolite with low levels in the lungs. While initial trials showed clinical improvement, more data is still needed.
Favipiravir is an antiviral drug being studied for the treatment of COVID-19. The document summarizes several studies on favipiravir including: a randomized controlled trial from China finding favipiravir led to faster viral clearance and improved chest imaging outcomes compared to lopinavir/ritonavir; observational data from Japan showing clinical improvement in most patients, especially those with mild/moderate disease; and a Russian study demonstrating improved viral clearance and fever relief with favipiravir versus standard of care. The document also reviews favipiravir's mechanism of action, potential adverse effects, and prescribing guidelines.
Treatment of hospital acquired, ventilator-associated, and healthcare-associa...Christian Wilhelm
This document discusses the treatment of hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP) in adults. It emphasizes the importance of appropriate antibiotic therapy based on risk factors for multidrug-resistant pathogens. For patients at higher risk, empiric broad-spectrum multidrug therapy is recommended. Once culture results are available, therapy should be narrowed based on susceptibility. Adherence to treatment guidelines has been shown to improve outcomes in some studies, but guidelines may fail to identify some patients at risk of drug-resistant bacteria.
This document discusses hospital acquired pneumonia (HAP), ventilator associated pneumonia (VAP), and healthcare associated pneumonia (HCAP). It provides definitions for these types of pneumonia and notes there is evidence many HCAP patients are not actually at high risk for multidrug-resistant pathogens. The document reviews attributable mortality and prolonged ICU/hospital stays related to VAP. It examines diagnostic challenges and recommends the use of endotracheal aspirate cultures over more invasive sampling methods. The document provides guidance on empiric treatment, de-escalation, length of therapy, and using biomarkers to discontinue antibiotics for VAP.
This document discusses issues in selecting appropriate non-inferiority margins or "deltas" in clinical trials comparing a new drug to an active control drug. It examines challenges in setting deltas for acute bacterial meningitis and hospital-acquired pneumonia based on historical data, disease severity, and practical trial considerations. For both conditions, the magnitude of benefit from antibiotics over placebo is unclear from old studies. A smaller delta reflecting less acceptable inferiority is preferable for severe diseases, but may require impractically large trials.
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but minimized to avoid overuse. Most patients can be treated for 7-8 days, but longer courses may be needed for certain multidrug-resistant pathogens.
Objectives:
1.To review the latest updates in the Canadian VAP Guidelines
2.To highlight the changes and why these changes are important
Read more and watch the recorded webinar: http://bit.ly/1sRCowQ
The study found that Ivermectin, an FDA-approved anti-parasitic drug, is able to inhibit the replication of SARS-CoV-2, the virus that causes COVID-19, in vitro. A single dose of Ivermectin resulted in a 5000-fold reduction in viral RNA at 48 hours in infected Vero-hSLAM cells. The authors hypothesize that Ivermectin acts by inhibiting the nuclear import of viral proteins through interaction with importin proteins. They conclude that Ivermectin warrants further investigation for potential benefits against COVID-19 in humans.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
This document discusses ventilator-associated pneumonia (VAP), including its definition, epidemiology, risk factors, diagnosis, prevention, and management. VAP is pneumonia that develops 48 hours or more after a patient has been put on a ventilator. It can occur in up to 28% of mechanically ventilated patients and the mortality rate is high at 27-76%. Risk factors include intubation type and route, prior antibiotic use, and comorbidities. Diagnosis involves clinical, microbiological, and radiological evidence. Prevention strategies include education, hand hygiene, ventilator circuit maintenance, oral decontamination, and the VAP bundle. Treatment recommendations include following local antibiograms and initially covering common
Triple combination of
interferon beta-1b, lopinavir – ritonavir, and ribavirin
in the treatment of patients admitted to hospital with COVID-19:
an open-label, randomized, phase 2 trial
This document discusses the development and implementation of new surveillance definitions for ventilator-associated events (VAEs) by the Centers for Disease Control and Prevention (CDC). It provides an overview of the limitations of previous ventilator-associated pneumonia (VAP) surveillance definitions and the objectives of the CDC to create a more reliable, objective approach. The new VAE definitions focus on ventilator settings and complications rather than clinical diagnosis of VAP. The definitions establish thresholds for worsening oxygenation that could indicate a ventilator-associated condition has occurred.
crp as a prognostic indicator in hospitalized patient with covid 19tanjinamuntakim1
C-reactive protein (CRP) levels were measured in 268 hospitalized COVID-19 patients to evaluate its utility as a prognostic indicator. Higher peak and slope of CRP in the first week, and median CRP levels throughout hospitalization correlated with worse outcomes including mortality, intubation and shorter hospital stay. Optimal CRP thresholds for predicting mortality were a maximum value of 250 mg/L in the first week and a slope greater than 10 mg/L. Elevated CRP thus serves as a sensitive marker for disease progression and severity in COVID-19 patients.
This document provides guidance on preventing ventilator-associated pneumonia (VAP) in adult and pediatric patients. It outlines the adult VAP bundle, which consists of 5 evidence-based practices: elevating the head of the bed, daily readiness-to-extubate evaluations, use of endotracheal tubes with subglottic secretion drainage, oral care with chlorhexidine, and early enteral nutrition. Additional recommended practices include hand hygiene, promoting patient mobility and autonomy, and VTE prophylaxis. For children, key practices are head elevation, proper tube positioning, and oral care. The document aims to help healthcare teams reduce VAP through a quality improvement approach.
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients on mechanical ventilation. It is caused by bacteria entering the lungs through the ventilation tube or tracheostomy. VAP increases ICU and hospital stays by 4-9 days and medical costs by $40,000-$50,000 per patient. Adhering to a VAP care bundle that includes keeping patients' heads of bed elevated, daily sedation vacations, DVT prophylaxis, stress ulcer prophylaxis, and daily oral care can reduce VAP rates by up to 65%.
Early Hydroxychloroquine but not Chloroquine use reduces ICU admission in COV...La Verità
1) An observational study of 1064 COVID-19 patients in Dutch hospitals found that early treatment with hydroxychloroquine (HCQ) on the first day of admission was associated with a 53% reduced risk of transfer to the intensive care unit (ICU) for mechanical ventilation, compared to untreated patients.
2) No significant effect was found of HCQ or chloroquine (CQ) treatment on mortality for patients on the COVID-19 ward.
3) The protective effect against ICU transfer was seen for HCQ but not for CQ, indicating these drugs cannot be considered interchangeable for COVID-19 treatment.
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated wit...La Verità
This study analyzed data from 3,451 COVID-19 patients hospitalized in Italy between February and May 2020 to investigate the relationship between hydroxychloroquine (HCQ) therapy and in-hospital mortality. The study found that 76.3% of patients received HCQ. After adjusting for patient characteristics, HCQ use was associated with a 30% lower risk of death compared to no HCQ use. The protective effect of HCQ appeared stronger in patients with elevated C-reactive protein levels at admission. Within the limitations of an observational study, the data do not discourage HCQ use for hospitalized COVID-19 patients while awaiting results from randomized controlled trials.
This document defines different types of pneumonia including community acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). It describes common clinical features, diagnostic testing recommendations including chest radiographs, severity assessment scores, and treatment guidelines based on patient risk factors and pneumonia type. Initial treatment often includes broad-spectrum antibiotics while considering possible multidrug-resistant pathogens, with options to address a lack of improvement such as fungal infections or tuberculosis.
Cовременное лечение ВИЧ : новые данные с конференции CROI 2017/ Contemporary...hivlifeinfo
Cовременное лечение ВИЧ : новые данные с конференции CROI 2017/ Contemporary Management of HIV. New Data From CROI 2017
In this downloadable slideset, Charles B. Hicks, MD, and Program Director Joseph J. Eron, Jr., MD, review key new HIV data presented at the Seattle 2017 meeting.
Topics include:
-Prevention
-New data on currently available ART
-Switch/simplification strategies for virologically suppressed patients
-Investigational ARV agents
-Treatment complications and comorbidities
Low-dose hydroxychloroquine therapy and mortality in hospitalised patients wi...La Verità
This study analyzed data from a nationwide surveillance of 8075 COVID-19 patients hospitalized in Belgium to compare in-hospital mortality between those treated with low-dose hydroxychloroquine (HCQ) monotherapy (2400 mg total over 5 days) and supportive care only. The HCQ-treated group had lower mortality (17.7% vs 27.1%). In a statistical analysis adjusting for demographic and clinical factors, HCQ treatment was independently associated with lower mortality compared to supportive care alone. Subgroup analyses found reduced mortality with HCQ for patients diagnosed both within 5 days and over 5 days from symptom onset.
This document discusses antibiotic choice in the ICU. It provides epidemiological data from studies on infections in ICU patients. The most common infections are pneumonia, bloodstream infections, and UTIs. The pathogens vary between different ICU profiles such as medical, surgical, and pediatric ICUs. Principles of antibiotic use include targeting the likely pathogen while minimizing toxicity. Empirical antibiotic choices are discussed for common ICU infections like pneumonia, bloodstream infections, and UTIs. Antimicrobial resistance is an increasing problem addressed as well.
This document discusses ventilator-associated pneumonia (VAP). It defines VAP as pneumonia occurring 48-72 hours or more after endotracheal intubation. The document reviews statistics on VAP incidence from studies, describes the complex pathophysiology of VAP, and outlines criteria for diagnosing VAP which includes new infiltrates on chest x-ray and signs of infection. It also summarizes treatment guidelines including collecting cultures before antibiotics and using short courses of broad-spectrum antibiotics. Finally, it emphasizes that implementing a high compliance VAP bundle is the most important prevention step and can significantly reduce VAP rates and healthcare costs.
Ventilator-associated pneumonia (VAP) is a common nosocomial infection that occurs in patients on mechanical ventilation. It can develop within the first 5 days of intubation or later after the 10th day. Risk factors include prolonged mechanical ventilation, comorbidities, and improper infection control practices. Common causative organisms include Streptococcus pneumoniae, Haemophilus influenzae, and methicillin-sensitive Staphylococcus aureus for early-onset VAP and Pseudomonas, MRSA, and drug-resistant Gram-negative rods for late-onset VAP. Diagnosis is based on clinical, microbiological, and radiological criteria though there is no gold standard. Treatment involves administering appropriate
Ομιλία – Παρουσίαση: «Ρεμδεσιβίρη- η εμπειρία με την αντι-ιική θεραπεία στην πανδημία COVID-19»
Ιωάννης Κατσαρόλης, MD, PhD, Παθολόγος-Λοιμωξιολόγος, Associate Director Medical Affairs, HIV-Antifungals-COVID19, Gilead Sciences Hellas and Cyprus
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but avoid excessive use by prescribing the minimum needed. Therapy for VAP due to Pseudomonas or Acinetobacter may require 15 days instead of the usual 8 days
ventilator Associated Pneumonia -By Dr.Tinku JosephDr.Tinku Joseph
This document discusses ventilator-associated pneumonia (VAP). It defines VAP, hospital-acquired pneumonia (HAP), and healthcare-associated pneumonia (HCAP). It describes the typical timelines used to define early versus late onset VAP. It identifies endotracheal intubation as a major risk factor for developing pneumonia. It also outlines various risk factors related to the patient, colonization, mechanical ventilation and medical devices. The document discusses pathways of bacterial entry and pathogenesis of VAP. It addresses challenges in diagnosis and outlines clinical, microbiological and radiological diagnostic methods and criteria. It concludes with a discussion of treatment approaches including empiric therapy, choice of antibiotics, and prevention strategies such as the ventil
Objectives:
1.To review the latest updates in the Canadian VAP Guidelines
2.To highlight the changes and why these changes are important
Read more and watch the recorded webinar: http://bit.ly/1sRCowQ
The study found that Ivermectin, an FDA-approved anti-parasitic drug, is able to inhibit the replication of SARS-CoV-2, the virus that causes COVID-19, in vitro. A single dose of Ivermectin resulted in a 5000-fold reduction in viral RNA at 48 hours in infected Vero-hSLAM cells. The authors hypothesize that Ivermectin acts by inhibiting the nuclear import of viral proteins through interaction with importin proteins. They conclude that Ivermectin warrants further investigation for potential benefits against COVID-19 in humans.
PATTERN OF HOSPITAL-ACQUIRED PNEUMONIA IN INTENSIVE CARE UNIT OF SUEZ CANAL U...Khaled Mohamed
Hospital-acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator-associated pneumonia occurs
after 48–72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive
Care Unit worldwide.
This document discusses ventilator-associated pneumonia (VAP), including its definition, epidemiology, risk factors, diagnosis, prevention, and management. VAP is pneumonia that develops 48 hours or more after a patient has been put on a ventilator. It can occur in up to 28% of mechanically ventilated patients and the mortality rate is high at 27-76%. Risk factors include intubation type and route, prior antibiotic use, and comorbidities. Diagnosis involves clinical, microbiological, and radiological evidence. Prevention strategies include education, hand hygiene, ventilator circuit maintenance, oral decontamination, and the VAP bundle. Treatment recommendations include following local antibiograms and initially covering common
Triple combination of
interferon beta-1b, lopinavir – ritonavir, and ribavirin
in the treatment of patients admitted to hospital with COVID-19:
an open-label, randomized, phase 2 trial
This document discusses the development and implementation of new surveillance definitions for ventilator-associated events (VAEs) by the Centers for Disease Control and Prevention (CDC). It provides an overview of the limitations of previous ventilator-associated pneumonia (VAP) surveillance definitions and the objectives of the CDC to create a more reliable, objective approach. The new VAE definitions focus on ventilator settings and complications rather than clinical diagnosis of VAP. The definitions establish thresholds for worsening oxygenation that could indicate a ventilator-associated condition has occurred.
crp as a prognostic indicator in hospitalized patient with covid 19tanjinamuntakim1
C-reactive protein (CRP) levels were measured in 268 hospitalized COVID-19 patients to evaluate its utility as a prognostic indicator. Higher peak and slope of CRP in the first week, and median CRP levels throughout hospitalization correlated with worse outcomes including mortality, intubation and shorter hospital stay. Optimal CRP thresholds for predicting mortality were a maximum value of 250 mg/L in the first week and a slope greater than 10 mg/L. Elevated CRP thus serves as a sensitive marker for disease progression and severity in COVID-19 patients.
This document provides guidance on preventing ventilator-associated pneumonia (VAP) in adult and pediatric patients. It outlines the adult VAP bundle, which consists of 5 evidence-based practices: elevating the head of the bed, daily readiness-to-extubate evaluations, use of endotracheal tubes with subglottic secretion drainage, oral care with chlorhexidine, and early enteral nutrition. Additional recommended practices include hand hygiene, promoting patient mobility and autonomy, and VTE prophylaxis. For children, key practices are head elevation, proper tube positioning, and oral care. The document aims to help healthcare teams reduce VAP through a quality improvement approach.
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients on mechanical ventilation. It is caused by bacteria entering the lungs through the ventilation tube or tracheostomy. VAP increases ICU and hospital stays by 4-9 days and medical costs by $40,000-$50,000 per patient. Adhering to a VAP care bundle that includes keeping patients' heads of bed elevated, daily sedation vacations, DVT prophylaxis, stress ulcer prophylaxis, and daily oral care can reduce VAP rates by up to 65%.
Early Hydroxychloroquine but not Chloroquine use reduces ICU admission in COV...La Verità
1) An observational study of 1064 COVID-19 patients in Dutch hospitals found that early treatment with hydroxychloroquine (HCQ) on the first day of admission was associated with a 53% reduced risk of transfer to the intensive care unit (ICU) for mechanical ventilation, compared to untreated patients.
2) No significant effect was found of HCQ or chloroquine (CQ) treatment on mortality for patients on the COVID-19 ward.
3) The protective effect against ICU transfer was seen for HCQ but not for CQ, indicating these drugs cannot be considered interchangeable for COVID-19 treatment.
Use of hydroxychloroquine in hospitalised COVID-19 patients is associated wit...La Verità
This study analyzed data from 3,451 COVID-19 patients hospitalized in Italy between February and May 2020 to investigate the relationship between hydroxychloroquine (HCQ) therapy and in-hospital mortality. The study found that 76.3% of patients received HCQ. After adjusting for patient characteristics, HCQ use was associated with a 30% lower risk of death compared to no HCQ use. The protective effect of HCQ appeared stronger in patients with elevated C-reactive protein levels at admission. Within the limitations of an observational study, the data do not discourage HCQ use for hospitalized COVID-19 patients while awaiting results from randomized controlled trials.
This document defines different types of pneumonia including community acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). It describes common clinical features, diagnostic testing recommendations including chest radiographs, severity assessment scores, and treatment guidelines based on patient risk factors and pneumonia type. Initial treatment often includes broad-spectrum antibiotics while considering possible multidrug-resistant pathogens, with options to address a lack of improvement such as fungal infections or tuberculosis.
Cовременное лечение ВИЧ : новые данные с конференции CROI 2017/ Contemporary...hivlifeinfo
Cовременное лечение ВИЧ : новые данные с конференции CROI 2017/ Contemporary Management of HIV. New Data From CROI 2017
In this downloadable slideset, Charles B. Hicks, MD, and Program Director Joseph J. Eron, Jr., MD, review key new HIV data presented at the Seattle 2017 meeting.
Topics include:
-Prevention
-New data on currently available ART
-Switch/simplification strategies for virologically suppressed patients
-Investigational ARV agents
-Treatment complications and comorbidities
Low-dose hydroxychloroquine therapy and mortality in hospitalised patients wi...La Verità
This study analyzed data from a nationwide surveillance of 8075 COVID-19 patients hospitalized in Belgium to compare in-hospital mortality between those treated with low-dose hydroxychloroquine (HCQ) monotherapy (2400 mg total over 5 days) and supportive care only. The HCQ-treated group had lower mortality (17.7% vs 27.1%). In a statistical analysis adjusting for demographic and clinical factors, HCQ treatment was independently associated with lower mortality compared to supportive care alone. Subgroup analyses found reduced mortality with HCQ for patients diagnosed both within 5 days and over 5 days from symptom onset.
This document discusses antibiotic choice in the ICU. It provides epidemiological data from studies on infections in ICU patients. The most common infections are pneumonia, bloodstream infections, and UTIs. The pathogens vary between different ICU profiles such as medical, surgical, and pediatric ICUs. Principles of antibiotic use include targeting the likely pathogen while minimizing toxicity. Empirical antibiotic choices are discussed for common ICU infections like pneumonia, bloodstream infections, and UTIs. Antimicrobial resistance is an increasing problem addressed as well.
This document discusses ventilator-associated pneumonia (VAP). It defines VAP as pneumonia occurring 48-72 hours or more after endotracheal intubation. The document reviews statistics on VAP incidence from studies, describes the complex pathophysiology of VAP, and outlines criteria for diagnosing VAP which includes new infiltrates on chest x-ray and signs of infection. It also summarizes treatment guidelines including collecting cultures before antibiotics and using short courses of broad-spectrum antibiotics. Finally, it emphasizes that implementing a high compliance VAP bundle is the most important prevention step and can significantly reduce VAP rates and healthcare costs.
Ventilator-associated pneumonia (VAP) is a common nosocomial infection that occurs in patients on mechanical ventilation. It can develop within the first 5 days of intubation or later after the 10th day. Risk factors include prolonged mechanical ventilation, comorbidities, and improper infection control practices. Common causative organisms include Streptococcus pneumoniae, Haemophilus influenzae, and methicillin-sensitive Staphylococcus aureus for early-onset VAP and Pseudomonas, MRSA, and drug-resistant Gram-negative rods for late-onset VAP. Diagnosis is based on clinical, microbiological, and radiological criteria though there is no gold standard. Treatment involves administering appropriate
Ομιλία – Παρουσίαση: «Ρεμδεσιβίρη- η εμπειρία με την αντι-ιική θεραπεία στην πανδημία COVID-19»
Ιωάννης Κατσαρόλης, MD, PhD, Παθολόγος-Λοιμωξιολόγος, Associate Director Medical Affairs, HIV-Antifungals-COVID19, Gilead Sciences Hellas and Cyprus
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but avoid excessive use by prescribing the minimum needed. Therapy for VAP due to Pseudomonas or Acinetobacter may require 15 days instead of the usual 8 days
ventilator Associated Pneumonia -By Dr.Tinku JosephDr.Tinku Joseph
This document discusses ventilator-associated pneumonia (VAP). It defines VAP, hospital-acquired pneumonia (HAP), and healthcare-associated pneumonia (HCAP). It describes the typical timelines used to define early versus late onset VAP. It identifies endotracheal intubation as a major risk factor for developing pneumonia. It also outlines various risk factors related to the patient, colonization, mechanical ventilation and medical devices. The document discusses pathways of bacterial entry and pathogenesis of VAP. It addresses challenges in diagnosis and outlines clinical, microbiological and radiological diagnostic methods and criteria. It concludes with a discussion of treatment approaches including empiric therapy, choice of antibiotics, and prevention strategies such as the ventil
This document discusses healthcare-associated pneumonia (HCAP). It defines HCAP, hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). It discusses the challenges in diagnosing and treating HCAP due to imperfect diagnostic tests and conditions that can mimic pneumonia. The document also summarizes several studies comparing the etiology and outcomes of HCAP versus community-acquired pneumonia (CAP), finding higher rates of drug-resistant pathogens and worse outcomes in HCAP. It recommends antibiotics that provide coverage for possible multidrug-resistant pathogens in patients at risk.
The document discusses healthcare-associated pneumonia (HCAP). Traditionally, pneumonia was classified as community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). However, some patients presenting with pneumonia as outpatients have been found to be infected with multidrug-resistant pathogens associated with HAP. This has led to the new category of HCAP, which bridges CAP and HAP. Studies have found that the etiology of HCAP is more similar to HAP, with higher prevalence of pathogens like MRSA and Pseudomonas aeruginosa. Patients with HCAP are at greater risk of more severe illness, infection with multidrug-resistant pathogens, and receiving inappropriate antibiotic therapy, leading to higher mortality compared to CAP
1) Three studies showed lower mortality for patients with bacteremic pneumococcal pneumonia treated with antibiotic combination therapy compared to monotherapy.
2) Combination therapy including a beta-lactam plus macrolide is recommended for critically ill patients and those with bacteremic pneumococcal pneumonia based on evidence showing lower mortality compared to fluoroquinolone combinations or monotherapy.
3) The optimal duration of combination therapy for bacteremic pneumococcal pneumonia is unclear but guidelines recommend limiting it to 3-5 days once the pathogen is identified.
This document discusses a case of ventilator-associated pneumonia (VAP) in a long-term ventilated patient. It provides details on the patient's history, exam findings, labs, imaging and treatment. VAP is a common ICU infection that occurs in intubated patients after 48 hours of mechanical ventilation. Risk factors include prolonged ventilation, comorbidities, and host factors. Treatment involves empiric antibiotics targeted against likely pathogens based on onset and institutional epidemiology. Prevention strategies center around a multidisciplinary VAP bundle approach.
This document discusses a case of ventilator-associated pneumonia (VAP) in a long-term ventilated patient. It provides details on the patient's history, examination findings, investigations, and treatment. VAP is a common nosocomial infection in the ICU that occurs within 48 hours of mechanical ventilation. Prolonged ventilation increases the risk of developing VAP. The document reviews risk factors, pathogenesis, diagnosis, treatment and prevention of VAP.
This document provides information on community-acquired pneumonia (CAP). It discusses the epidemiology, clinical presentation, diagnosis, treatment, and pathogens associated with CAP. Key points include: CAP affects millions annually in North America, with Streptococcus pneumoniae being the most common pathogen. Clinical features may include cough, fever, sputum production, and dyspnea. Diagnosis is made clinically with chest imaging showing infiltrates. Treatment involves antibiotic selection based on severity and risk factors for multidrug-resistant organisms.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
VAP/HAP management guidelines by IDSA/ATS (2016) -: Dr.Tinku JosephDr.Tinku Joseph
This document discusses ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP). It defines VAP and HAP and outlines their incidence and impact. Guidelines for diagnosing VAP/HAP using microbiologic methods and biomarkers like CPIS are presented. The document reviews controversies around defining healthcare-associated pneumonia (HCAP) and its inclusion in future guidelines. Empiric and pathogen-directed treatment options for VAP/HAP are discussed, along with optimizing antibiotic dosing and the potential role of inhaled antibiotics.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
This document discusses management of mold infections, focusing on Aspergillus. It describes a case of a kidney transplant recipient presenting with COVID-19 who developed invasive pulmonary aspergillosis. Imaging showed multiple pulmonary nodules and cavities. Treatment with voriconazole was started based on positive serum galactomannan and CT findings consistent with aspergillosis. The risk of aspergillosis is increased in patients with severe COVID-19, especially those receiving corticosteroids and with ARDS. Diagnosis relies on imaging, galactomannan testing and culture/pathology when possible. Voriconazole and other azoles are first-line treatments but require monitoring for
Newly Approved Agents: Lefamulin, the first systemic pleuromutilin antibiotic, was approved by the FDA in August 2019 (after the societies’ approval of the guidelines) for the treatment of adults with CAP caused by S pneumoniae, methicillin-susceptible S aureus (MSSA), H influenzae, Legionella pneumophila, M pneumoniae, and C pneumoniae.11,12 Lefamulin acts as a bacterial protein synthesis inhibitor by targeting the peptidyl transferase center of the 50S bacterial ribosomal subunit. It may be given either IV or orally at a dosage of 150 mg IV every 12 hours or 600 mg orally every 12 hours, with dosage adjustment required for patients with hepatic impairment. Lefamulin may prolong the QT interval, and its use should be avoided in patients who have known QT prolongation or are taking other QT-prolonging agents. Lefamulin has several other drug interactions. Its use should be avoided (because of potential for reduced efficacy) with strong or moderate CYP3A inducers or P-glycoprotein (Pgp) inducers. The oral formulation of lefamulin should not be used with agents that are that are strong CYP3A inhibitors or Pgp inhibitors or with CYP3A4 substrates that prolong the QT interval. Lefamulin may cause fetal harm, and females should be counseled to use effective contraception during treatment and for 2 days after completion of therapy.11-13
Delafloxacin, a fluoroquinolone antibiotic, was approved in October 2019 (after the guidelines were published) for treatment of adults with CAP caused by S pneumoniae, MSSA, selected gram-negative pathogens (Klebsiella pneumoniae, Escherichia coli, P aeruginosa, H influenzae, Haemophilus parainfluenzae), and atypical microorganisms (C pneumoniae, L pneumophila, M pneumoniae).14 It may be given either IV or orally at a dosage of 300 mg IV every 12 hours or 450 mg orally every 12 hours, with adjustment required for patients with severe renal impairment. Delafloxacin has the same warnings and precautions as other agents in the fluoroquinolone antimicrobial class.14,15
Directed Treatment
The patient’s clinical response should be evaluated after initiation of antimicrobial therapy. In cases where blood and/or sputum cultures are recommended, once microbiology culture and sensitivity results are available, antibiotic coverage should be deescalated and therapy should be directed at the pathogen(s) causing disease.4,9
Duration of Therapy
The recommended duration of antibiotic therapy has not changed from previously published guidelines. Patients with CAP should be treated for a minimum of 5 days, with antibiotic therapy continued until the patient achieves clinical stability. Validated measures of clinical stability include resolution of vital sign abnormalities (heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature); ability to eat; and normal mental status. Given that most patients achieve clinical stability within 48 to 72 hours after therapy initiation, a 5-day course typically is sufficient
K.S. Filos, MD PhD Selective Gut DecontaminationKriton Filos
The document discusses selective decontamination of the digestive tract (SDD), a method used to prevent infections in intensive care unit (ICU) patients. It describes how SDD works by using topical antibiotics in the mouth and stomach to eliminate harmful bacteria while preserving normal flora. Meta-analyses of clinical trials show that SDD reduces ICU-acquired pneumonia rates by 60-70% and mortality by 10-30%. However, long-term antibiotic use may promote resistance. Overall, SDD is effective for preventing infections but its use requires consideration of local resistance patterns and strict hygiene protocols.
HAP/VAP 2016 ATS/IDSA Guidelines. Our Data available at: https://rdcu.be/Mx8EDr Sandeep Kumar
Management of Adults With Hospital-acquired and
Ventilator-associated Pneumonia: 2016 Clinical Practice
Guidelines by the Infectious Diseases Society of America
and the American Thoracic Society.
To see our study results on HCAP and HAP, VISIT https://link.springer.com/article/10.1007/s00408-018-0117-7
The document discusses the management of bacterial pneumonia. It covers the use of antibiotic therapy as the mainstay of treatment, with choices of first-line antibiotics depending on the causative bacteria. It also discusses determining the need for hospitalization, administering respiratory support and fluid resuscitation, and using empiric broad-spectrum antibiotic therapy for hospitalized patients. The document provides tables on first- and second-line antibiotic choices for specific organisms and guidelines on inpatient and outpatient empiric antibiotic regimens.
This patient is a 77-year-old woman admitted to the ICU with a stroke who has now developed hospital-acquired pneumonia. She has risk factors including COPD, recent intubation, and NG tube feeding. Laboratory results show increased white blood cell count and creatinine. Initial empiric antimicrobial therapy should cover typical and atypical pathogens, including Pseudomonas if risk factors are present. Therapy should be de-escalated once culture results are available. Generally, 7-8 days of antimicrobial therapy is sufficient for hospital-acquired pneumonia.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
Associate Professor Neil Orford is an intensive care specialist and Director of Intensive Care at University Hospital Geelong. Neil is the clinical lead for the i-Validate program. In this podcast he discusses this collaboration between Barwon Health and Deakin University which aims to improve patient-centred end-of-life care through training in clinical communication.
This document discusses cognitive impairment in ICU patients. It notes that approximately 36% of mechanically ventilated patients and 25-54% of all ICU patients demonstrate cognitive impairment 6-12 months after discharge. The impairment affects executive function, memory, and mental processing. Risk factors include hypoxemia, hyperglycemia, delirium duration, hypotension, and sedative use. Delirium occurs in 74-80% of ICU patients and is associated with hypoperfusion in brain regions. Prevention strategies may include exercise in ICU to reduce delirium rates and cognitive rehabilitation. Maintaining good sleep and reducing delirium are important to mitigate cognitive impairment.
Professor Andrew Davies is an Intensivist working at Peninsula Health in Melbourne. He has performed clinical research in the field of critical care for 20 years, as a participating investigator in over 50 studies (mostly clinical trials), predominantly in the areas of critical care nutrition, mechanical ventilation and acute lung injury and severe sepsis. He is a past Vice Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) with a special interest in nutrition in the ICU, and is a past Chair of the Australian and New Zealand Society of Parenteral and Enteral Nutrition (AuSPEN).
In this talk, Professor Davies tackles the often overlooked aspect of nutrition in the ICU and it’s potential benefits for our patients.
Kimberley Haines is a senior ICU physiotherapist and the Allied Health Research Lead at Western Health. Her academic research focusses on the long term progress of ICU survivors. Here she discusses the developing puzzle of ICU outcomes.
Professor Rinaldo Bellomo is an Intensivist at the Austin Hospital in Melbourne. He is Professor of Medicine at Melbourne University, and Honorary Professor of Medicine at Monash University, Melbourne and The University of Sydney.
He is one of the most eminent researchers in Intensive Care Medicine today and has been named one of the most influential scientific minds of our time.
In this thought-provoking talk Professor Bellomo discusses glycemic control of critically ill diabetic patients in the ICU.
David Anderson is an intensivist and medical donation specialist at the Alfred Hospital Melbourne. From a 2016 ICN Victoria meeting he discusses the coming epidemic of dementia and how its coming to an intensive care near you.
Associate Professor Vincent Pellegrino is a Senior Intensive Care Specialist at The Alfred Hospital and head of the ECMO Clinical Service. He has had a lead role in the development of ECMO services at The Alfred since 2003. From the ECMO CPR ICN Victoria meeting he discusses how to get patient selection and outcomes right for eCPR.
Jason Maclure is deputy director of Intensive Care at the Alfred Melbourne. He has strong interests in analgesia and sedation, respiratory failure, ventilation, HFOV and ECMO. From an ICN Victoria 2016 meeting on ECMO CPR he discusses the development of the eCPR protocol at the Alfred.
Professor Stephen Bernard is an Intensive Care Physician at The Alfred Hospital and Medical Advisor to Ambulance Victoria. His research interests include the use of therapeutic hypothermia for the treatment of neurological injury after resuscitation from out-of hospital cardiac arrest. Here he provides a presentation on recent advances in the management of refractory cardiac arrest in the out of hospital setting.
Huy Tran is a lab and clinical haematologist at Peninsula Health. He has research interests in haemostasis and thrombosis and is a member of the Australasian committee for anticoagulation reversal. Here he presents on the new oral anticoagulants and what can be done when they cause critical bleeding
Dr Sachin Gupta an intensivist at Peninsula Health presents on the difficulties we currently face in predicting bleeding and how this might change in the future.
This document discusses caring for pediatric patients in an adult ICU in Geelong, Victoria. It notes barriers to caring for pediatric patients and differences compared to adult patients. It outlines the adult ICU team's skills and collaboration needed with pediatrics. Equipment, monitoring, medications, and resources required are reviewed. Education for nursing on a 3 stage program and courses like APLS are mentioned. Outcomes have improved since establishing a pediatric ICU liaison service for transfers and telehealth support. The goal is for most pediatric patients to be managed locally in Geelong rather than transferring to Melbourne.
Dr Steve McGloughlin is an intensivist at the Alfred Hospital. He is also an infectious diseases specialist and maintains both clinical and research interests in infections in critically ill patients. Here he discusses the ongoing primacy of antibiotics in intensive care and our continuing battle with antibiotic resistance
1. Mentoring is important for career progression and personal development, but biases can exist in mentoring relationships.
2. Effective mentoring requires reflecting on one's own assumptions and treating all mentees equally, based on their individual needs and goals.
3. Overcoming biases in mentoring requires empathy, establishing trust, and making changes at both the individual and organizational levels.
ICN Victoria presents Professor Oliver Cornely, Professor of Internal Medicine and Director for Clinical Trials at University Hospital, Cologne, Germany. His research interests include invasive fungal diseases in haematology/oncology and in the ICU setting. Dr Cornely is also a clinical infectious diseases consultant at the University Hospital of Cologne.
Professor Cornely gives an entertaining talk on the pervasiveness, invasiveness, diagnosis and treatment of fungal infections in ICU patients.
ICN Victoria presents Dr Andy Buck, Emergency Physician and Director of the well regarded Emergency Trauma Management course, talking the how's, why's and what's of teaching Gen Y doctors.
ICN Victoria presents Dr Andy Buck, Emergency Physician and Director of the well regarded Emergency Trauma Management course, talking on managing the resuscitation room, a teamwork approach to CRM.
Dr Andrew Davies, Intensivist at Frankston Hospital, talks on burnout for intensivists, how to prevent it, what to do if you get there, and simple tips for living a more productive life generally. Inspiring, introspective and pragmatic.
ICN Victoria presents Professor Jack Iwashyna, giving a thought provoking talk on how we may better use data from ANZICS large RCTs to guide management of our critically ill patients.
ICN Victoria presents Dr Aiden Burrell talking on the diagnosis, clinical features and treatment of right ventricular failure for the Intensive Care Specialist
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
ICN Victoria: Feldman on "Pneumonia in ICU"
1. Pneumonia Phenotypes –Pneumonia Phenotypes –
the Alphabet Soupthe Alphabet Soup
Charles Feldman
Professor of Pulmonology and Chief Physician
Charlotte Maxeke Johannesburg Academic Hospital
University of the Witwatersrand
2. The Alphabet Soup of Pneumonia - TopicsThe Alphabet Soup of Pneumonia - Topics
Community Nosocomial
CAP VAT
CABP VAE
NHAP VAC
HCAP IVAC
HAP VAP
Other
3. Pneumonia occurring >48 hours after endotracheal intubation
Risk factors for MDR bacteria causing VAP
Presence of HCAP or HAP risk factors for MDR
VAP
Pneumonia occurring > 48 hours after hospital admission
Risk factors for MDR bacteria causing HAP
Antibiotic therapy within 90 days of infection
Current hospitalization of ≥5 days
High frequency of antibiotic resistance in community or
specific hospital unit
Immunosuppressive disease of therapy
Presence of HCAP risk factors for MDR
HAP
Anand N et al. Semin Respir Crit Care Med 2009; 30: 3-9
The Alphabet Soup of PneumoniaThe Alphabet Soup of Pneumonia
Pneumonia occurring ≤ 48 hours of hospital admission in
patients who do not meet the criteria for HCAP
CAP
4. First introduced in 1978 by GARB et al
Has become an accepted phenotype
Leading cause of morbidity in nursing home residents
and frequently a terminal event
Most patients have one (89-97%) or more co-morbidities
– especially neurological and/or cardiac
Fewer typical symptoms and confusion common
Frequently more severe – clinical and risk scores
Controversy regarding aetiology, although
pneumococcus is a leading cause and GNB and SA rare
Mortality is higher
NHAP
Klapdor B et al. Eur Respir Monogr 2014; 63: 105-116
The Alphabet Soup of PneumoniaThe Alphabet Soup of Pneumonia
5. Pneumonia occurring ≤48 hours of hospital admission in patients
with ≥1 of the following risk factors for MDR bacteria as cause of
infection:
Hospitalization for ≥ 2 days in acute-care facility within 90 days
of infection
Residence in a nursing home or long-term care facility
Antibiotic therapy, chemotherapy, or wound care within 30 days
of current infection
Haemodialysis treatment at a hospital or clinic
Home infusion therapy or home wound care
Family member with infection due to MDR bacteria
HCAP
The Alphabet Soup of PneumoniaThe Alphabet Soup of Pneumonia
Anand N et al. Semin Respir Crit Care Med 2009; 30: 3-9
6. Included in IDSA/ATS guideline for NP in 2005
Essentially NHAP patients and patients with co-morbid illness
who have hospital contact and antibiotics – greater risk of
MDR pathogens
Based on a few, mainly USA, studies
Not found in subsequent studies in USA, Japan, Korea and
Europe
Recent meta-analysis demonstrated similar mortality when
adjusted for co-morbidity
No link between MDR pathogens and mortality – functional
status more important driver of mortality
Reject as possible phenotype
HCAP
The Alphabet Soup of PneumoniaThe Alphabet Soup of Pneumonia
Klapdor B et al. Eur Respir Monogr 2014; 63: 105-116
7. 0 5 10 15 20 25
Patient mortality
Kolief MH, et al. Chest 2005;128 3854
Micek S, et al. Antimicrob Agents Chemother 2007;51:3568
Carratala J, et al. Arch Intern Med 2007;167 1393
P=0.007
P<0.001
P<0.001
CAP
HCAP
Mortality in Patients with CAP and HCAPMortality in Patients with CAP and HCAP
Anand N et al. Semin Respir Crit Care Med 2009; 30: 3-9
8. Mortality from Multi-drug Resistant Infections
Maybe MDR pathogens represent more
invasive pathogens
Partly related to inappropriate choice of empiric
antibiotic therapy
Partly related to the underlying diseases that
are putting patients at risk of MDR pathogens
that also place them at greater risk of a higher
mortality
9. Proposed Algorithm for HCAP TherapyProposed Algorithm for HCAP Therapy
Severe pneumonia
Assess severity of illness (need for mechanical ventilation, ICU admit)
AND
Presence of risk factors for MDR pathogens (recent antibiotics, recent
hospitalization, poor functional status, immune suppression)
HCAP is present: From a nursing home, recent hospitalization,
haemodialysis, home infusion therapy
No Yes
Group 1 (0 – 1 risks)
Treat for common CAP
pathogens (consider
oral Rx) Quinolone or β-
lactam / macrolides.
Group 2 (≥ 2 risks)
Consider hospital.
Treat for MDR
pathogens with HAP
therapy.
Group 3 (0 risks)
Treat for severe
pneumonia in hospital.
β-lactam PLUS
macrolide or quinolone.
Group 4 (≥ 1 risks)
Treat for MDR
pathogens with HAP
recommendations.
Use 3 drugs.
Brito V et al. Curr Opin Infect Dis 2009; 22: 316-325
21. Characteristics of the Included Studies
CharcteristicsCharcteristics
TotalTotal
DesignDesign
ProspectiveProspective
RetrospectiveRetrospective
Definition of HCAPDefinition of HCAP
ATS/DSA definitionATS/DSA definition
Alternative definitionAlternative definition
GeographyGeography
North AmericaNorth America
EuropeEurope
AsiaAsia
Duration of follow-up for outcome assessmentDuration of follow-up for outcome assessment
In hospitalIn hospital
30 days30 days
UnclearUnclear
Quality assessmentQuality assessment
GoodGood
ModerateModerate
PoorPoor
Number of studiesNumber of studies
2424
99
1515
55
1919
33
99
1212
1111
1111
22
44
1010
1010
Chalmers JD et al. Clin Infect Dis 2014; 58: 330-339
22. COMMUNITY-ACQUIRED
CABP
CAP in the elderly
CAP in the younger patient
CAP in COPD patients
Aspiration pneumonia
Other Considerations
The Alphabet Soup of PneumoniaThe Alphabet Soup of Pneumonia
23. In the ER, CAP should be suspected on the
grounds of typical clinical symptoms/signs
and confirmed with chest radiograph
In elderly and patients with altered mental
state, CAP should be considered even
without typical symptoms
Once diagnosed assessment should be made
of severity – e.g. PSI, CURB-65, CRB-65
According to risk, site of care should be
identified
Assess risk of MDR pathogens
Antibiotic therapy based on severity and MDR
risk
Approach to CAP ManagementApproach to CAP Management
Klapdor B et al. Eur Respir Monogr 2014; 63: 105-116
25. Nasopharyngeal colonizationNasopharyngeal colonization
Background secretionsBackground secretions
Leak around ETT cuffLeak around ETT cuff
ETT BiofilmETT Biofilm
Host lung defensesHost lung defensesBacterial pathogensBacterial pathogens
Colonization
VAT
VAP
Craven DE et al. Clin Infect Dis 2010; 51: S59-S66
26. VAP Rates in Selected CountriesVAP Rates in Selected Countries
20
18
16
14
12
10
MeanVAPsper1000ventilatordays
6
4
2
0
8
USA
M
edical
USA
Surgical
Italy
AustriaScotland
France
Spain
Belgium
IN
ICC
Post-intervention
Klompas M. Curr Opin Infect Dis 2012; 25: 176-182
27. 10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
2004 2005 2006 2007 2008 2009
1500
2000
1000
2500
3000
500
0
VAPcasesper1000ventilatordays
NumberofhospitalreportingtoCDC
Surgical ICUs
Medical ICUs
Mean VAP rate
Klompas M. Curr Opin Infect Dis 2012; 25: 176-182
VAP Rates in the USAVAP Rates in the USA
28. New onset of purulent sputum or
change in character of sputum or
increased respiratory secretions
or increased suctioning
requirements
Two of theTwo of the
followingfollowing
New or progressive
and persistent
infiltrate
One of theOne of the
followingfollowing
Two or more serialTwo or more serial
radiographs with at leastradiographs with at least
one of the followingone of the following
New onset of worsening cough or
dyspnea, or tachypnea
Leukopenia (<4000
WBC/µL) or
leukocytosis (>12,000
WBC/ µL )
Consolidation
Rales or bronchial breath sounds
For adults ≥70 years
old, altered mental
status with no other
recognised cause
Cavitation
Worsening gas exchange (e.g.
oxygen desaturation, increased
oxygen requirements, or
increased ventilator demand)
Klompas M. Curr Opin Infect Dis 2012; 25: 176-182
CDC Clinical Definition for VAPCDC Clinical Definition for VAP
Fever (>38°C or
>100.4o
F)
29. Simplified Version of the CPISSimplified Version of the CPIS
ValueValueComponentComponent
Temperature °C
PointsPoints
≥ 36.5 and ≤ 38.4
≥ 38.5 and ≤ 38.9
≥ 39.0 and ≤ 36.0
≥ 4 000 and ≤ 11 000
< 4 000 or > 11 000
Blood leukocytes per mm2
0
1
2
0
1
Few
Moderate
Large
Purulent
Tracheal secretions 0
1
2
+1
> 240 or presence of ARDS
≤ 240 or absence of ARDS
Oxygenation Pao2/Fio2,mm
Mg
0
2
No infiltrate
Patchy or diffuse infiltrate
Localised infiltrate
Chest radiograph 0
1
2
Luna C et al. Crit Care Med 2003; 31: 676-682
30. Diagnostic Accuracy of CPIS: A Meta-analysisDiagnostic Accuracy of CPIS: A Meta-analysis
Detailed evaluation
14
Detailed evaluation
14
Assessed with
QUADAS
15
Assessed with
QUADAS
15
Included in the meta-
analysis
13
Included in the meta-
analysis
13
Potentially relevant papers
retrieved from the databases
19
Potentially relevant papers
retrieved from the databases
19
Excluded based on title
or abstract
5
Excluded based on title
or abstract
5
Excluded irrelevant
10
Excluded irrelevant
10
Additional studies
identified in reference lists
11
Additional studies
identified in reference lists
11
Excluded insufficient
data
2
Excluded insufficient
data
2
Shan J et al. Respiratory Care 2011; 56: 1087-1094
34. VAE Definition Algorithm Summary
Respiratory
status
component
Patient on mechanical ventilation >2 days
Baseline period of stability or improvement, followed by
sustained period of worsening oxygenation
Ventilator-associated condition (VAC)
General evidence of infection/inflammation
Infection-related ventilation-associated complication (IVAC)
Positive or probable VAP
Positive results of microbiological testing
Infection /
inflammation
component
Additional
evidence
No CXR
needed!
After www.cdc.org
35. Did not meetDid not meet
criteriacriteria
n=39n=39
Did not meetDid not meet
criteriacriteria
n=52n=52
Did not meetDid not meet
criteriacriteria
n=76n=76
EnrolledEnrolled
n=10n=10
EnrolledEnrolled
n=39n=39
EnrolledEnrolled
n=43n=43
SurvivorsSurvivors
n=2n=2
NonsurvivorsNonsurvivors
n=10n=10
SurvivorsSurvivors
n=9n=9
NonsurvivorsNonsurvivors
n=6n=6
SurvivorsSurvivors
n=3n=3
Nonsurvivors2nNonsurvivors2n
=2=2
SepsisSepsis
n=259n=259
Respiratory ICURespiratory ICU
n=82n=82
Surgical ICUSurgical ICU
n=91n=91
Emergency ICUEmergency ICU
n=86n=86
VAPVAP
n=12n=12
Non-VAPNon-VAP
n=31n=31
VAPVAP
n=15n=15
Non-VAPNon-VAP
n=24n=24
VAPVAP
n=5n=5
Non-VAPNon-VAP
n=5n=5
Diagnosing VAP in Critically Ill PatientsDiagnosing VAP in Critically Ill Patients
Su L-X et al. Am J Crit Care 2012; 21: e110-e119
36. 1.0
0.8
0.4
0.2
0.0
0.2 0.4 0.6 0.8 1.00.0
Sensitivity
0.6
1-Specificity
0.2 0.4 0.6 0.8 1.00.0
1-Specificity
CPIS WBC
sTREM-1PCT
Ref line
sTREM-1 + CPIS
sTREM-1 + WBC
Ref line
A B
Diagnostic Value in VAPDiagnostic Value in VAP
Su L-X et al. Am J Crit Care 2012; 21: e110-e119
37. 1.0
0.8
Sensitivity
0.2 0.4 0.6 0.8 1.0
1-Specificity
0.6
0.4
0.2
0.0
0.0
PCT + CPIS
CPISPCT
Ref line
Prognostic Value in VAPPrognostic Value in VAP
Su L-X et al. Am J Crit Care 2012; 21: e110-e119
38. Initial Empirical Therapy for VAPInitial Empirical Therapy for VAP
CeftriaxoneCeftriaxone
oror
Levofloxacin, moxifloxacin orLevofloxacin, moxifloxacin or
ciprofloxacinciprofloxacin
oror
Ampicillin/sulbactamAmpicillin/sulbactam
oror
EtrapenemEtrapenem
Antipseudomonal cephalosporin (cefepime,
ceftazidime)
or
Antipseudomonal carbepenem (imipenem
or meropenem)
or
β-lactam/β-lactamase inhibitor (piperacillin-
tazobactam)
plus
Antipseudomonal fluroquinolone
(ciprofloxacin or levofloxacin)
or
Aminoglycoside (amikacin, gentamicin or
tobramyicin)
plus
Linezolid or vancomycin (if risk factors for
MRSA are present)
VAP with no risk factors
for MDR pathogens
VAP with risk factors
for MDR pathogens
Joseph NM et al. Eur J Int Med 2010; 21: 360-368
39. Short course vs. Prolonged Antibiotic TherapyShort course vs. Prolonged Antibiotic Therapy
No. of studiesNo. of studies No. of participantsNo. of participants Statistical methodStatistical method Effect sizeEffect sizeOutcome/ subgroup titleOutcome/ subgroup title
28-day mortality 2 431 Odds Ratio
(M-H, Random, 95% CI)
1.08 (0.66, 1.76)
Recurrence of pneumonia 3 508 Odds Ratio
(M-H, Random, 95% CI)
1.37 (0.87, 2.17)
28-d antibiotic-free days 2 431 Mean Difference
(IV, Random, 95% CI)
4.02 (2.26, 5.78)
ITU mortality 2 107 Odds Ratio
(M-H, Random, 95% CI)
0.85 (0.37, 1.91)
Non-res. of pneumonia 1 77 Odds Ratio
(M-H, Fixed. 95% CI)
0.89 (0.49, 7.40)
In-hospital mortality 1 401 Odds Ratio
(M-H, Fixed, 95% CI)
1.09 (0.71, 1.67)
Recurrence - multi-resistant
organism
1 110 Odds Ratio
(M-H, Fixed. 95% CI)
0.44 (0.21, 0.95)
Duration of ITU stay 2 431 Mean Difference
(IV, Random, 95% CI)
-0.01 (- 2.30, 2.27)
Duration of hospital stay 1 30 Mean Difference
(IV, Fixed, 95% CI)
-1.0 (-4.11, 2.11)
Duration of mech. ventilation 2 107 Mean Difference
(IV, Random, 95% CI)
-0.01 (-0.57, 0.55)
28-day mechanical ventilation-
free days
2 431 Mean Difference
(IV, Random, 95% CI)
0.47 (-0.97, 1.92)
Mortality-associated with VAP 1 77 Mean Difference
(IV, Fixed, 95% CI)
1.0 (-8.85, 10.95)
Pugh R et al. Cochrane Database of Systematic Reviews 2012, Issue 2
40. Pharmacologic-based Strategies for Prevention of VAPPharmacologic-based Strategies for Prevention of VAP
Topical iseganan
Orodigestive decontamination
(topical/topical + IV antibiotics)
Oral chlororohexidine
Aerosolized antibiotics
IV antibiotics
Specific stress ulcer prophylaxis regimen
Short-course antibiotic therapy
(when clinically applicable)
Routine antibiotic cycling/rotation/heterogeneity
Restricted (conservative) blood transfusion
Vaccines (influenza, pneumococcal)
StrategyStrategy
No
No
Yes
Nil
Nil
No
Yes
No
Yes
Yes
RecommendationRecommendation
1
1
1
1
1
1
1
2
2
1
Evidence levelEvidence level
Kollef MH. Surgical Infections 2011; 12: 211-220