CME/CE – New Guidelines: Managing Hospital-Acquired Pneumonia & Ventilator-Associated Pneumonia

CME/CE – New Guidelines: Managing Hospital-Acquired Pneumonia & Ventilator-Associated Pneumonia
Author Information (click to view)

Andre C. Kalil, MD, MPH, FACP, FCCM, FIDSA

Professor, Division of Infectious Diseases
Department of Internal Medicine
University of Nebraska Medical Center

Andre C. Kalil, MD, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Review the latest update to the Infectious Diseases Society of America and American Thoracic Society joint clinical practice guidelines on the management of adults with hospital-acquired pneumonia and ventilator-associated pneumonia.

Method of Participation(click to view)

Release Date: 6/29/2017
Expiration Date: 6/29/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at intivahealth.akhcme.com/procial/lessons/4.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. dcotterman@akhcme.com.

Credit Available(click to view)

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Chris Cole – Managing Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Andre C. Kalil, MD, MPH, FACP, FCCM, FIDSA

Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.

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Andre C. Kalil, MD, MPH, FACP, FCCM, FIDSA (click to view)

Andre C. Kalil, MD, MPH, FACP, FCCM, FIDSA

Professor, Division of Infectious Diseases
Department of Internal Medicine
University of Nebraska Medical Center

Andre C. Kalil, MD, has indicated to Physician’s Weekly that he has no financial interests to disclose.

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The Infectious Diseases Society of America and the American Thoracic Society have released joint clinical practice guidelines on the management of adults with hospital-acquired pneumonia and ventilator-associated pneumonia.
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Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are estimated to account for 20% to 25% of all hospital-acquired infections, and about 10% to 15% of these cases are fatal. In 2005, the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) published a guideline on the management of adults with HAP and VAP (HAP/VAP). Knowledge regarding the diagnosis and treatment of HAP/VAP evolved and changed substantially in the 11 years following the release of this guideline, according to Andre C. Kalil, MD, MPH. As a result of these recent advancements, the IDSA and ATS updated their recommendations (Table) and published them in Clinical Infectious Disease.

 

Key Updates

For many years, antibiotic therapy courses were administered for 14 to 21 days, explains Dr. Kalil. “Duration of treatment varied greatly in the past because there was little evidence to delineate the optimal length of therapy in patients with HAP/VAP,” he says. “When the guideline panel pulled together a systematic review of the research from the last 10 to 15 years, it became evident that these patients can be treated effectively and safely with a shorter, 7-day course of antibiotic therapy. Most patients can clear the infection in the way we would expect. Some patients may require an even shorter course, whereas others may require a longer course. This variation depends on the improvement of clinical, radiologic, and laboratory parameters. That said, the consensus among the panelists is that 7 days should be the generally recommended course of therapy for patients with HAP/VAP.”

Dr. Kalil also notes that a 7-day course provides similar efficacy to a 10- or 14-day course while exposing patients to fewer unnecessary antibiotics as well as drug side effects. In addition, this shorter course can reduce risks for the development of Clostridium difficile colitis or diarrhea and bacterial resistance problems that can result from prolonged antibiotic exposure. The administration of fewer antibiotics may also result in lower costs.

The updated IDSA/ATS guideline also recommends that every institution develop their own antibiogram as a systematic approach to understanding which microorganisms are the most prevalent in their hospital, ICU, ward, or any other site in which patients are admitted and could potentially develop HAP/VAP. “When clinicians are provided with their own specific antibiogram on a regular basis, they have a much higher probability of treating these infections with the appropriate antibiotic,” says Dr. Kalil. “Microbiology culture results typically take a couple days to be returned. Knowing the bacterial flora that live in a unit or hospital allows empirical treatment to be more accurate.”

 

Wide-Ranging Benefits

Dr. Kalil says it is important to note that the IDSA/ATS recommendations were written in a way to purposely give clinicians room to be flexible. Medical decisions at the bedside have individual needs and vary from patient to patient. “We didn’t intend these recommendations to be prescriptive or rigidly followed,” Dr. Kalil says. “Instead, the intent is to provide a general approach that we believe can benefit most patients but still leaves room for the clinician to address individual needs of patients with HAP/VAP.”

The IDSA/ATS writing group hopes that adherence with the updated guideline recommendations will help clinicians improve how they care for their patients with HAP/VAP infections. “We provide guidance to improve patient care on an individual basis,” says Dr. Kalil. “In addition, the hope is that they will benefit institutions throughout the United States by reducing the use of unnecessary antibiotics and reducing antibacterial resistance. Implementing these recommendations may help us accomplish these goals.”

Readings & Resources (click to view)

Kalil A, Metersky M, Klompas M, Muscedere J, Sweeney D, Palmer L, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-e111. Available at http://cid.oxfordjournals.org/content/63/5/e61.

American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA). Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit CareMed. 2005;171:388-416.

Sopena N, Sabria M; Neunos Study Group. Multicenter study of hospital-acquired pneumonia in non-ICU patients. Chest. 2005; 127:213-219.

Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS). Supplemental material for the management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Available at: www.idsociety.org/Organ_System/#HospitalAcquiredVentilatorAssociatedPneumoniaHAPVAP.

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