PDF(Sci-hub)
Abstract：
BACKGROUND: Hospital-associated pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. Many aspects of the treatment of HAP caused by multi-resistant Gram-positive microorganisms have been extensively studied, but controversial issues remain.
OBJECTIVE: The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Is combination antibiotic therapy or monotherapy more effective in the treatment of HAP? (2) What role do pharmacokinetic/pharmacodynamic antibiotic features have as a guide in the selection of treatment for HAP? (3) Is a de-escalation approach for the management of HAP effective? An analysis of the studies published up until April 2009 is presented and discussed in detail.
METHODS: A systematic literature search using PubMed, MEDLINE, and EMBASE databases and the Cochrane Library was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence was applied.
OBJECTIVE: The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Is combination antibiotic therapy or monotherapy more effective in the treatment of HAP? (2) What role do pharmacokinetic/pharmacodynamic antibiotic features have as a guide in the selection of treatment for HAP? (3) Is a de-escalation approach for the management of HAP effective? An analysis of the studies published up until April 2009 is presented and discussed in detail.
METHODS: A systematic literature search using PubMed, MEDLINE, and EMBASE databases and the Cochrane Library was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence was applied.
摘要：
背景：尽管抗菌治疗取得了进展，医院相关性肺炎（HAP）仍然是发病率和死亡率的重要原因。由多重耐药革兰氏阳性微生物引起的HAP的治疗的许多方面已经被广泛研究,但是有争议的问题仍然存在。
目标：这个GISIG（GruppoItalianodiStudiosulleInfezioniGravi）工作组——一个多学科专家小组——的目标是使用基于证据的分析方法为一些有争议的问题定义建议。有争议的问题是：（1）联合抗生素疗法或单一疗法在治疗HAP方面更有效吗？（2）药代动力学/药效学抗生素特征在选择HAP治疗方面具有什么作用？（3）HAP管理的降级方法是否有效？对截至2009年4月发表的研究进行了分析并进行了详细讨论。
方法：使用PubMed进行系统的文献检索，MEDLINE,和EMBASE数据库和Cochrane图书馆进行。使用CONSORT方法从原始研究中提取证据，以评估随机临床试验和用于病例对照研究的纽卡斯尔-渥太华质量评估量表，纵向队列，和回顾性研究。采用分级方法对证据质量进行分级。
目标：这个GISIG（GruppoItalianodiStudiosulleInfezioniGravi）工作组——一个多学科专家小组——的目标是使用基于证据的分析方法为一些有争议的问题定义建议。有争议的问题是：（1）联合抗生素疗法或单一疗法在治疗HAP方面更有效吗？（2）药代动力学/药效学抗生素特征在选择HAP治疗方面具有什么作用？（3）HAP管理的降级方法是否有效？对截至2009年4月发表的研究进行了分析并进行了详细讨论。
方法：使用PubMed进行系统的文献检索，MEDLINE,和EMBASE数据库和Cochrane图书馆进行。使用CONSORT方法从原始研究中提取证据，以评估随机临床试验和用于病例对照研究的纽卡斯尔-渥太华质量评估量表，纵向队列，和回顾性研究。采用分级方法对证据质量进行分级。
