Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia.

A summary of the evidence and recommendations made in the ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia http://ow.ly/S3zA30iZfLa.

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia

Nosocomial pneumonia is a frequent infection that is classified into two groups [1]: HAP, which develops in hospitalised patients after 48 h of admission, and does not require (but may include) artificial ventilation at the time of diagnosis [2, 3]; and VAP, which occurs in intensive care unit (ICU) patients who have received mechanical ventilation for at least 48 h [2, 3]. HAP is the second most common hospital infection and has the highest crude mortality, while VAP is the most frequent cause of nosocomial infection in the ICU [2, 3]. Both types of pneumonia lengthen hospital stay and consume considerable health resources [2, 3]. Recently, the ERS, ESICM, ESCMID and ALAT published clinical guidelines on the therapeutic and management strategies for adult patients with HAP and VAP, designed to guide clinical decisions made not only by pulmonologists and intensivists but by all health professionals who treat these patients [2]. These clinical guidelines are evidence-based (Grading of Recommendations Assessment, Development and Evaluation) and follow the PICO ( population-intervention-comparison-outcome) model. Each section in this article refers to a specific PICO question addressed in the guidelines.