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    Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices

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    Author
    O'Hara, L.M.
    Kenaa, B.
    Richert, M.E.
    Claeys, K.C.
    Shipper, A.
    Sullivan, K.V.
    Schrank, G.M.
    Morgan, D.J.
    Shanholtz, C.
    Leekha, S.
    Date
    2019
    Journal
    Current Infectious Disease Reports
    Publisher
    Springer
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1007/s11908-019-0708-3
    Abstract
    Purpose of Review: Ventilator-associated pneumonia (VAP) is one of the most common infections in the ICU. Prompt diagnosis is vital as mortality increases with delayed antibiotic therapy. However, accurate diagnosis is challenging due to non-specific clinical features in a complicated patient cohort. Microbiological culture data remains a crucial aspect in confirming diagnosis. Recent Findings: Literature data comparing the benefit of invasive respiratory sampling to non-invasive is inconclusive. Differences in culturing practices translate in overidentification of organisms of unclear significance. Positive culture data in a low pre-test probability does not differentiate between true infection and colonization resulting in overtreatment. Furthermore, there are also opportunities for modifying the reporting of respiratory tract cultures that can better guide antimicrobial therapy. Summary: Under the umbrella of antimicrobial stewardship, diagnostic stewardship can be incorporated to create a systematic approach that would target culturing practices to match the right pre-test probability. Ideal outcome will be targeting cultures to the right patient population and minimizing unnecessary treatment.
    Keyword
    Antimicrobial stewardship
    Diagnostic stewardship
    Endotracheal aspirate
    Invasive respiratory culturing
    Selective culture reporting
    Ventilator-associated pneumonia
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075364824&doi=10.1007%2fs11908-019-0708-3&partnerID=40&md5=76431ca78d8df5b733845079ec5a539e; http://hdl.handle.net/10713/13147
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11908-019-0708-3
    Scopus Count
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