%0 Consensus Development Conference
%T Consensus document on controversial issues for the treatment of hospital-associated pneumonia.
%A Franzetti F
%A Antonelli M
%A Bassetti M
%A Blasi F
%A Langer M
%A Scaglione F
%A Nicastri E
%A Lauria FN
%A Carosi G
%A Moroni M
%A Ippolito G
%A  
%J Int J Infect Dis
%V 14
%N 0
%D Oct 2010
%M 20863734
%F 12.074
%R 10.1016/j.ijid.2010.05.008
%X <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.