Ventilator-associated pneumonia: impact of organisms on clinical resolution and medical resources utilization.


BACKGROUND:Clinical resolution of ventilator-associated pneumonia (VAP) determines the duration of treatment and mechanical ventilation. The aim of this study was to evaluate the influence of organisms and their susceptibility to treatment on outcomes. METHODS:Prospective observational study in three teaching ICUs. Sixty episodes of VAP with appropriate therapy (Haemophilus influenzae, 15 episodes; methicillin-sensitive Staphylococcus aureus [MSSA], 15 episodes; Pseudomonas aeruginosa, 15 episodes; and methicillin-resistant S aureus [MRSA], 15 episodes), and 30 episodes with initial inappropriate therapy, all due to P aeruginosa, were compared. The main outcome measures were clinical resolution variables and, in survivors, length of mechanical ventilation after VAP onset. RESULTS:A significant delay in the resolution of hypoxemia was observed in VAP episodes due to MRSA and P aeruginosa with inappropriate antibiotic therapy (IAT) (median time to resolution, 10 and 8 days, respectively) when compared with the remaining pathogens (median time to resolution, 2 days). A multiple regression model, adjusted for disease severity, confirmed the delayed clinical resolution for MRSA and P aeruginosa with IAT. Similar associations were documented for defervescence. Among survivors, the median duration of mechanical ventilation after VAP onset was significantly longer for MRSA (17 days) and P aeruginosa IAT (11 days) when compared with episodes due to H influenzae or MSSA (6 days). Multiple regression analysis, adjusted for disease severity, confirmed that MRSA required significantly (R(2) = 0.132; p < 0.01) longer respiratory support than other organisms. CONCLUSIONS:When treated promptly, the resolution of VAP due to MSSA, H influenzae, and P aeruginosa was comparable. The resolution of MRSA VAP, regardless of the appropriateness of initial antibiotic therapy, was associated with longer respiratory support.






Vidaur L,Planas K,Sierra R,Dimopoulos G,Ramirez A,Lisboa T,Rello J




Has Abstract


2008-03-01 00:00:00
















  • Medical literature and vena cava filters: so far so weak.

    abstract:STUDY OBJECTIVE:With the development of percutaneous inferior vena cava (IVC) filters, IVC interruption has become a widely used procedure in patients with or at risk for venous thromboembolism. In an attempt at clarifying the indications for filter placement, a systematic literature review was undertaken. DESIGN:Bibl...


    pub_type: 杂志文章,评审


    authors: Girard P,Stern JB,Parent F

    更新日期:2002-09-01 00:00:00

  • O2 uptake kinetics in response to exercise. A measure of tissue anaerobiosis in heart failure.

    abstract::Oxygen uptake (VO2) reflects the rate of aerobic regeneration of high-energy phosphate compounds (primarily adenosine triphosphate [ATP]). Since lactate increase is thought to result from an inadequate rate of aerobic ATP regeneration, it might be expected that lactate increase would be associated with a delayed attai...


    pub_type: 杂志文章


    authors: Zhang YY,Wasserman K,Sietsema KE,Ben-Dov I,Barstow TJ,Mizumoto G,Sullivan CS

    更新日期:1993-03-01 00:00:00

  • Continuous six-month infusion of intravenous nitroglycerin in a patient awaiting cardiac transplantation.

    abstract::We report a patient with ischemic cardiomyopathy who was treated with a continuous high dose infusion of intravenous nitroglycerin for six months while awaiting cardiac transplantation. Surprisingly, methemoglobinemia did not develop and nitroglycerin continued to be clinically effective in relieving angina during the...


    pub_type: 杂志文章


    authors: Perry GY,Murali S,Uretsky BF

    更新日期:1991-11-01 00:00:00

  • Effects of Random Measurement Error on Lung Cancer Screening Decisions: A Retrospective Cohort-Based Microsimulation Study.

    abstract:BACKGROUND:Self-reported tobacco pack-year history plays a large role in decisions about low-dose CT screening for lung cancer, yet is challenging to measure accurately. RESEARCH QUESTION:To what extent does random measurement error in pack-year information impact screening decisions and screening effectiveness? STUD...


    pub_type: 杂志文章


    authors: Caverly TJ,Zhang X,Hayward RA,Zhu J,Waljee AK

    更新日期:2020-09-14 00:00:00

  • Bronchiolitis obliterans and Nocardia asteroides infection of the lung.

    abstract::This report describes a patient with right lower lung (RLL) pneumonia of a subacute nature. Sputum and bronchial washings both grew N asteroides. Open lung biopsy showed bronchiolitis obliterans. Both the clinical and radiologic picture dramatically improved during three weeks of treatment with trimethoprim and sulfam...


    pub_type: 杂志文章


    authors: Camp M,Mehta JB,Whitson M

    更新日期:1987-12-01 00:00:00

  • Serum angiotensin-converting enzyme is elevated in association with underground coal mining.

    abstract::Serum angiotensin-converting enzyme activity (SACE) and lysozyme activity were measured in a group of 40 underground coal miners and two control groups, 20 subjects with sarcoidosis and 15 normal non-dust-exposed volunteers. The miners were grouped first according to whether they had recent exposure (still actively mi...


    pub_type: 杂志文章


    authors: Thompson AB,Cale WF,Lapp NL

    更新日期:1991-10-01 00:00:00

  • Acute and transient ST segment elevation during bacterial shock in seven patients without apparent heart disease.

    abstract::Acute elevation of the ST segment in several ECG leads was observed in seven patients with bacterial shock during the course of therapy. Six patients had bacterial pneumonia, one had acute cholecystitis, and none had a previous history of heart disease. At the onset of the ST elevation, all patients were receiving dop...


    pub_type: 杂志文章


    authors: Terradellas JB,Bellot JF,Sarís AB,Gil CL,Torrallardona AT,Garriga JR

    更新日期:1982-04-01 00:00:00

  • Respiratory infection complicating long-term tracheostomy. The implication of persistent gram-negative tracheobronchial colonization.

    abstract::Colonization of the lower respiratory tract by enteric Gram-negative bacilli (EGNB) has been a frequent finding in patients with long-term tracheostomies; however, the association of hospitalization and certain features of serious illness with this phenomenon has not been clearly established. Because such factors can ...


    pub_type: 杂志文章


    authors: Niederman MS,Ferranti RD,Zeigler A,Merrill WW,Reynolds HY

    更新日期:1984-01-01 00:00:00

  • Sleep apnea syndrome and cerebral hemodynamics.

    abstract::The dynamics of cerebral blood flow velocity (CBFV) during sleep were investigated in the right middle cerebral artery of 10 patients with sleep apnea syndrome (SAS) (mean age, 37 years) and 10 healthy control subjects (mean age, 32 years) throughout the entire sleep period. A computer-assisted pulsed (2 MHz) transcra...


    pub_type: 杂志文章


    authors: Hajak G,Klingelhöfer J,Schulz-Varszegi M,Sander D,Rüther E

    更新日期:1996-09-01 00:00:00

  • An unusual presentation of metastatic colon cancer to the lung.

    abstract::A 75-year-old man with a history of resected colon carcinoma presented to his primary care physician because of a new onset of coughing. The patient had expectorated a small piece of solid tissue; pathologic examination of the tissue found it to be consistent with metastatic colon adenocarcinoma. After further work-up...


    pub_type: 杂志文章


    authors: Zias EA,Owen RP,Borczuk A,Reichel J,Frater RW

    更新日期:1998-01-01 00:00:00

  • Preventing ARDS: progress, promise, and pitfalls.

    abstract::Advances in critical care practice have led to a substantial decline in the incidence of ARDS over the past several years. Low tidal volume ventilation, timely resuscitation and antimicrobial administration, restrictive transfusion practices, and primary prevention of aspiration and nosocomial pneumonia have likely co...


    pub_type: 杂志文章


    authors: Beitler JR,Schoenfeld DA,Thompson BT

    更新日期:2014-10-01 00:00:00

  • Pulmonary artery thrombus detection by magnetic resonance imaging.

    abstract::We report a patient in whom cardiac magnetic resonance imaging detected a clinically unsuspected pulmonary artery thromboembolus. Follow-up MRI after surgical removal of the thromboembolus showed normal pulmonary arteries. This case illustrates the potential utility of MRI in the detection and follow-up of central pul...


    pub_type: 杂志文章


    authors: Szucs RA,Rehr RB,Tatum JL

    更新日期:1989-01-01 00:00:00

  • Dynamics of left ventricular diastolic filling during exercise: a Doppler echocardiographic study of boys 10 to 14 years old.

    abstract:STUDY OBJECTIVE:Factors influencing diastolic filling of the left ventricle may serve as critical determinants of both maximal cardiac output and oxygen uptake. This study was conducted to assess diastolic filling dynamics of the left ventricle during progressive upright cycle exercise in children. METHODS:Twelve boys...


    pub_type: 杂志文章


    authors: Rowland T,Mannie E,Gawle L

    更新日期:2001-07-01 00:00:00

  • Effect of weight reduction on respiratory function and airway reactivity in obese women.

    abstract:BACKGROUND:Population-based studies have documented an association between obesity and an increased prevalence of asthma in women. METHODS:We prospectively studied 58 obese women with a body mass index of > 30 kg/m(2), 24 of whom had asthma, who were enrolled in an intensive 6-month weight loss program to determine wh...


    pub_type: 杂志文章


    authors: Aaron SD,Fergusson D,Dent R,Chen Y,Vandemheen KL,Dales RE

    更新日期:2004-06-01 00:00:00

  • Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD.

    abstract:OBJECTIVE:To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers, both of which were identified in a population-based epidemiologic study. DESIGN AND PARTICIPANTS:This is an epidemiologic, multicenter, population-based study conducted in seven ...


    pub_type: 杂志文章,多中心研究


    authors: Jiménez-Ruiz CA,Masa F,Miravitlles M,Gabriel R,Viejo JL,Villasante C,Sobradillo V

    更新日期:2001-05-01 00:00:00

  • Reversal of central sleep apnea using nasal CPAP.

    abstract::Based on the theory that obstructive (OSA) and central (CSA) sleep apneas share common pathophysiologic mechanisms, we attempted to treat eight patients with predominantly CSA by continuous positive airway pressure (CPAP). All patients exhibited repetitive episodes of CSA and mixed sleep apneas (MSA) in the supine pos...


    pub_type: 杂志文章


    authors: Issa FG,Sullivan CE

    更新日期:1986-08-01 00:00:00

  • Methodology for guideline development for the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

    abstract::This article describes the methodology for the Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Guideline authors began by specifying the population, the intervention and alternative, and the outcomes for each clinical question, and d...


    pub_type: 杂志文章


    authors: Schünemann HJ,Munger H,Brower S,O'Donnell M,Crowther M,Cook D,Guyatt G

    更新日期:2004-09-01 00:00:00

  • Therapeutic potential of mesenchymal stem cells for severe acute lung injury.

    abstract::Preclinical studies indicate that allogeneic human mesenchymal stem cells (MSC) may be useful for the treatment of several clinical disorders, including sepsis, acute renal failure, acute myocardial infarction, and more recently, acute lung injury (ALI). This article provides a brief review of the biologic qualities o...


    pub_type: 杂志文章,评审


    authors: Matthay MA,Thompson BT,Read EJ,McKenna DH Jr,Liu KD,Calfee CS,Lee JW

    更新日期:2010-10-01 00:00:00

  • Silicosis and tuberculosis.

    abstract::Two subjects had silicosis complicated by tuberculosis. In both patients, there was a relapse of the tuberculosis after chemotherapy was discontinued, in one case after 13 years of therapy with isoniazid and p-aminosalicylic acid. It would appear that the risk of tuberculosis in subjects with silicosis persists for li...


    pub_type: 杂志文章


    authors: Morgan EJ

    更新日期:1979-02-01 00:00:00

  • Antibiotic utilization: is there an effect on antimicrobial resistance?

    abstract::The antimicrobial resistance problem in hospitals continues to worsen. In particular, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and vancomycin-resistant enterococci (VRE) are significant causes of morbidity and mortality among critically ill patients. Treating infections caused by thes...


    pub_type: 杂志文章,评审


    authors: Patterson JE

    更新日期:2001-02-01 00:00:00

  • Massive hemoptysis from a pulmonary artery aneurysm associated with an emphysematous bulla.

    abstract::A 66-year-old man with a history of COPD and Aspergillus fumigatus infection developed massive hemoptysis. Pulmonary artery angiography revealed an aneurysm which was successfully treated with coil embolization. This is the first known report of a pulmonary artery aneurysm causing massive hemoptysis in a patient with ...


    pub_type: 杂志文章


    authors: Bowler RP,Durham J,Schwarz MI

    更新日期:1998-04-01 00:00:00

  • Activation of bronchial epithelial cells in smokers without airway obstruction and patients with COPD.

    abstract:STUDY OBJECTIVE:The aim of this study was to investigate the basal level as well as the tumor necrosis factor (TNF)-alpha- and interferon (IFN)-gamma-induced expression and release of the neutrophil chemoattractants interleukin (IL)-8 and growth-related oncogene (GRO)-alpha in primary bronchial epithelial cells (PBECs)...


    pub_type: 杂志文章


    authors: Schulz C,Krätzel K,Wolf K,Schroll S,Köhler M,Pfeifer M

    更新日期:2004-05-01 00:00:00

  • Serial exercise testing in pulmonary embolism.

    abstract::A patient underwent exercise testing during evaluation for unexplained dyspnea. Evidence of ventilation-perfusion mismatch was noted and subsequent testing revealed multiple pulmonary emboli. Ventilation perfusion parameters by serial exercise testing progressively improved during the course of the patient's illness b...


    pub_type: 杂志文章


    authors: Helmers RA,Zavala DC

    更新日期:1988-09-01 00:00:00

  • Health-care costs and exercise capacity.

    abstract:BACKGROUND:While the beneficial effect of exercise capacity on mortality is well-accepted, its effect on health-care costs remains uncertain. This study investigates the relationship between exercise capacity and health-care costs. METHODS:The Veterans Affairs Health Care System recently implemented a Decision Support...


    pub_type: 杂志文章


    authors: Weiss JP,Froelicher VF,Myers JN,Heidenreich PA

    更新日期:2004-08-01 00:00:00

  • Lymphocytic alveolitis after primary HIV infection with CMV coinfection.

    abstract::Herein is a report of an adult case of primary HIV infection with cytomegalovirus coinfection causing cough, fever, and lymphocytic alveolitis. Primary HIV infection has not been previously reported as a cause of lymphocytic alveolitis. ...


    pub_type: 杂志文章


    authors: Jouveshomme S,Couderc LJ,Ferchal F,Vignon D,Autran B,Balloul E,Caubarrere I

    更新日期:1997-10-01 00:00:00

  • Thrombolysis with tissue plasminogen activator in suspected acute myocardial infarction. The ASSET Study.

    abstract::Intravenous rtPA (total dose, 100 mg over 3 h) was compared with placebo in a prospective, randomized, double-blind trial in 5,011 patients with suspected AMI of less than 5 h duration. No ECG or enzymatic confirmation of the diagnosis was required for study entry. At 1 month 9.8% of patients given placebo had died co...


    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Wilcox RG

    更新日期:1989-05-01 00:00:00

  • The effects of helium-hyperoxia on 6-min walking distance in COPD: a randomized, controlled trial.

    abstract:BACKGROUND:We hypothesized that breathing helium-hyperoxia (HeO2) would significantly improve 6-min walking test (6MWT) distance in COPD subjects. METHODS:This was a blinded, randomized crossover study. At visit 1, we assessed pulmonary function, exercise capacity, and 6MWT distance. Visits 2 and 3 consisted of four 6...


    pub_type: 杂志文章,随机对照试验


    authors: Marciniuk DD,Butcher SJ,Reid JK,MacDonald GF,Eves ND,Clemens R,Jones RL

    更新日期:2007-06-01 00:00:00

  • Thrombocytopenia in the intensive care unit.

    abstract:STUDY OBJECTIVE:To determine the prevalence of thrombocytopenia in an ICU and assess which factors were associated with thrombocytopenia. DESIGN:A review of the medical records of patients admitted during 3 separate months during 1 academic year. Patients must have survived at least 12 h in the ICU. SETTING:A medical...


    pub_type: 杂志文章


    authors: Baughman RP,Lower EE,Flessa HC,Tollerud DJ

    更新日期:1993-10-01 00:00:00

  • Time-dependent effect of nitrate-rich meals on exhaled nitric oxide in healthy subjects.

    abstract:BACKGROUND:Exhaled nitric oxide (eNO) is a convenient noninvasive marker for airway inflammation in several pulmonary diseases. However, external factors such as nitrate-rich nutrition can affect the levels of eNO and thus compromise its diagnostic value. STUDY OBJECTIVES:The objective of this investigation was to hav...


    pub_type: 杂志文章


    authors: Vints AM,Oostveen E,Eeckhaut G,Smolders M,De Backer WA

    更新日期:2005-10-01 00:00:00

  • Frequency dependent phase and amplitude differences between simulated mouth and pleural pressures during panting. Demonstration with a mechanical model.

    abstract::A mechanical model was employed to examine phase and amplitude relationships between simulated pleural and mouth pressures during panting at different frequencies with and without lower airway obstruction and with rigid or flaccid extrathoracic airways. Results confirm the hypothesis that, in the presence of lower air...


    pub_type: 杂志文章


    authors: Knudson RJ,Knudson DE

    更新日期:1984-10-01 00:00:00