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Diagnosis and management of nosocomial pneumonia 

Diagnosis and management of nosocomial pneumonia
Chapter:
Diagnosis and management of nosocomial pneumonia
Author(s):

Jean Chastre

DOI:
10.1093/med/9780199600830.003.0117
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date: 26 February 2020

Quantitative culture techniques, performed before the introduction of new antibiotics, enable physicians to identify most patients who need immediate treatment for nosocomial pneumonia, and help select optimal therapy in a safe, well-tolerated manner. These techniques avoid resorting to broad-spectrum coverage of all patients with a clinical suspicion of infection, and may minimize the emergence of resistant micro-organisms in the intensive care unit. However, the full impact of this decision tree on patient outcome remains controversial. Antimicrobial therapy of patients with nosocomial pneumonia is a two-stage process. The first stage involves administering broad-spectrum antibiotics at doses maximizing bacterial killing as soon as possible to avoid inadequate treatment in patients with true bacterial pneumonia. The second stage focuses on trying to achieve this objective without overusing or abusing antibiotics. This will need the combination of a number of different steps, including commitment to focused and narrow treatment once the aetiological agents are known, switching to monotherapy after day 3, and shortening duration of therapy to 7–8 days in most patients, as dictated by the patient’s clinical response and microbiological information.

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