समुदाय-अर्जित निमोनिया में Pseudomonas aeruginosa जोखिम के साथ अन्य जीवाणु निमोनिया का उपचार

References

1. We recommend clinicians only cover empirically for MRSA or P. aeruginosa in adults with CAP if locally validated risk factors for either pathogen are present (strong recommendation, moderate quality of evidence).
2. The most consistently strong individual risk factors for respiratory infection with MRSA or P. aeruginosa are prior isolation of these organisms, especially from the respiratory tract, and/or recent hospitalization and exposure to parenteral antibiotics.
3. Empiric treatment options for P. aeruginosa include piperacillin-tazobactam (4.5 g every 6 h), cefepime (2 g every 8 h), ceftazidime (2 g every 8 h), aztreonam (2 g every 8 h), meropenem (1 g every 8 h), or imipenem (500 mg every 6 h).
4. The duration of therapy for CAP due to suspected or proven MRSA or P. aeruginosa should be 7 days, in agreement with the recent hospital-acquired pneumonia and ventilator-associated pneumonia guidelines.
5. Routine cultures in patients empirically treated for MRSA or P. aeruginosa allow deescalation to standard CAP therapy if cultures do not reveal a drug-resistant pathogen and the patient is clinically improving at 48 hours.
6. We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days (strong recommendation, moderate quality of evidence).

DOI: 10.1164/rccm.201908-1581ST