Antibioticuseincriticalcare.pptVIP

De-escalation therapy Applicability of this strategy, failed Absence of microbiological results Isolation of multi-resistant pathogens preventing de-escalation Reluctance of some clinicians to change antibacterials in patients with a favorable clinical course despite persistence of severity of illness Despite limitations, antibacterial de-escalation therapy has been recommended ATS guideline for the management of adults with hospital acquired, ventilator associated, and healthcare associated pneumonia, AJRCCM 2005;171:388-416 YUMC Recommendations for starting/stopping antibiotics based on the PRORATA study.21 Adapted from Figure 1 in Bouadma et al.21. Kibe S et al. J. Antimicrob. Chemother. 2011;66:ii33-ii40 ? The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@ Antibacterial cycling The scheduled rotation of one class of antibacterials One or more different classes with comparable spectra of activity Different mechanisms of resistance Some weeks and a few months Objective Reduce the appearance of resistances by replacing the antibacterial before they occur and preserving its activity to be re-introduced in the hospital in a later cycle YUMC Pre-emptive therapy The administration of antimicrobials in certain patients at very high risk of opportunistic infections before the onset of clinical signs of infection Developed in hematological patients and/or transplant recipients based on the use of serological tests that advanced the diagnosis of some infections CMV, aspergillosis In critical illness patients to patients at high risk of candidemia or invasive candidiasis : In the absence of serological test to establish an early diagnosis of invasive candidiasis, different scores based on clinical and/or microbiological data YUMC A bedside scoring system (Candida score) for preemptive antifungal treatment in nonneutro