![]() ![]() 6 Early evaluation of all risk factors for MDR pathogens is performed routinely in our hospital. The choice of antibiotic is based on the severity of infection and risk of MDR pathogens. Empiric treatment must target staphylococcus aureus, Pseudomonas aeruginosa, and other gram-negative bacilli.Monitoring: Assess response after 48–72 hours and 5–7 days.Treatment will be switched if the culture indicates the presence of GNB. As GNB are not commonly isolated from patients with CAP, we do not empirically start specific treatment for MDR-GNB.Recommendations for empiric antimicrobial therapy of CAP and HAP/VAP in adult gram-negative pneumonia are summarised as follows. Other specimens may also be collected based on the clinical judgement of the physician in charge, such as blood, pleural fluid, bronchoalveolar lavage specimen, bronchoscopic aspirate or endotracheal aspirate. Regular pre-treatment sampling includes sputum specimens and two blood cultures, except in an outpatient setting. 6 Based on the guidelines, all hospitalised patients with pneumonia will have lower respiratory tract samples collected before initiating antibiotic treatment. We follow the American Thoracic Society / Infectious Diseases Society of America (ATS/ IDSA) guidelines in the clinical approach to patients with gram-negative pneumonia. 5 GNB are the most frequently implicated pathogenic bacteria in HAP, the predominant organisms being multidrug resistant (MDR) Pseudomonas aeruginosa and Acinetobacter baumannii.Īpproach to the treatment of gram-negative pneumonia 4 Notably, HAP accounts for the majority (79.4%) of hospital-acquired infection in ICU settings in Vietnam, which leads to prolonged hospital stays, increased expenses and patient mortality. 3 Moreover, GNB are the most common cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) GNB may be present in up to 90% of cases. 3 Patients with CAP due to GNB infection also require intensive care unit (ICU) admission and mechanical ventilation more frequently. While GNB are only found in 8–15% cases of community-acquired pneumonia (CAP), these organisms account for acute respiratory failure, severe sepsis or septic shock significantly more frequently compared with gram-positive bacteria. For instance, annual microbiological reports from the Vinmec International Hospital showed that GNB comprised approximately 80–85% of the isolated bacteria from either sputum or bronchoalveolar lavage fluid samples. In Vietnam, gram-negative bacteria (GNB) are the most frequently isolated organisms in samples from patients with lower respiratory tract infections. Q1: What is your approach to the treatment of gram-negative pneumonia? ![]() 2ĭr Thuy discusses her experiences in the treatment of gram-negative pneumonia with combination therapy and her insights on the role of the quinolone levofloxacin in combination therapy. ![]() 1 Available evidence suggests that empirical use of quinolones in combination therapy may provide beneficial outcomes, owing to their relatively broad spectrum of antimicrobial activity and acceptable safety profile. Combination antibiotic therapy has been recommended by several medical societies for the treatment of pneumonia, particularly for patients, with invasive infections caused by gram-negative bacteria. ![]()
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