Spitlal #7, ICU, Mo...
 
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Spitlal #7, ICU, Moscow, Russian Federation; 2Moscow Medical Academy, Moscow, Russian Federation
Spitlal #7, ICU, Moscow, Russian Federation; 2Moscow Medical Academy, Moscow, Russian Federation
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Spitlal #7, ICU, Moscow, Russian Federation; 2Moscow Professional medical Academy, Moscow, Russian Federation; 3State Clinical College of Russia, Moscow, Russian Federation Important Treatment 2006, 10(Suppl 1):P107 (doi:ten.1186/cc4454) Aim To evaluate the efficiency of antibacterial protocol in intense trauma patients within the incidence and mortality of VAP. Methods This review was accepted with the local ethics committee. A equivalent examination of incidence, attributive mortality (chisquare examination) and pathogens of VAP in significant trauma patients was done in the course of two periods: 2001 (right before introduction of protocol) and 2004 (immediately after introduction of protocol) a long time. The formulated protocol provided: 1. Abandoning of antibiotic prophylaxis of VAP. two. Intrusion conditions of early diagnostics of VAP. three. Exclusion of all cefalosporine I II generation, aminoglycosides and fluoroquinolones as empiric treatment of VAP. 4. Cefepime PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/6800653 or cefoperazone/sulbactam (APACHE II rating twenty) were used as empiric treatment of VAP. five. Efficacy of antibiotic procedure was evaluated following forty eight hours. 6. Carbapenems and/or vancomycin was extra if empiric therapy was inefficient. While in the situation of suspected prognosis of VAP, microbiological evaluation DOTATATE of broncoalveolar lavage fluid (BAL) was performed. Success Within this review were being integrated 499 clients with intense trauma and respiratory aid for for a longer period than forty eight hrs (2001, 220 people and 2004, 279 individuals). There was no variation in ISS and APACHE II rating amongst the teams. The incidence of VAP was ten in 2001 (22/220) and nine in 2003 (25/279), distinction not sizeable. The attributive mortality thanks to VAP in 2001 was 63 (14/22) and in 2004 was 24 (6/25) (P < 0.01). A widespread using of broad-spectrum antibiotics shifted the structure of nosocomial pathogens. We observed a decrease in the rate of MRSA and a significant increase in the rate of Klebsiella pneumoniae (from 0.6 to 18.1 , most strains were resistant to cefalosporine III) and Acinetobacter baumanii (from 1.2 to 12.3 , most strains were resistant to ceftazidime). Conclusions Intrusion of antibacterial protocol in patients with multiple trauma and VAP results in a decrease of attributive mortality (P < 0.01) without a change in incidence of VAP.imipenem, ceftazidime, ofloxacin, ciprofloxacin, vacomycin. We measured antibiotic consumption with the antimicrobial density (AD), which takes into account the quantity of antibiotics in grams converted to the defined daily dose (DDD) and the number of days of hospitalization. The DDD was proposed by the World Health Organisation. The calculation of the AD for each molecule was carried out according to the following formula: AD = (quantity consumed [g] for the particular antimicrobial ?1000) / (DDD for that antimicrobial ?number of days hospitalized). The study of the total consumption of antibiotics showed a peak in 2002. The distribution by families of antibiotics shows variations according to various molecules. Among oxacillin, a significant decrease in the consumption of this molecule was observed in 2004 (AD = 44 in 2004 vs AD = 128.2 in 2002). At the same time, a significant increase in the consumption of vancomycin (AD = 28.15 in PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/8750913 2002 vs 73.nine into 2004) was also observed. This intense utilization of vancomycin was explained because of the large incidence from the methicillin-resistant Staphylococcus aureus inside our melt away office (MRSA = sixty four in 2004). As somewhere else, no vancomycin intermediate S. aureus was.

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