{Reference Type}: Consensus Development Conference
{Title}: Consensus document on controversial issues for the treatment of hospital-associated pneumonia.
{Author}: Franzetti F;Antonelli M;Bassetti M;Blasi F;Langer M;Scaglione F;Nicastri E;Lauria FN;Carosi G;Moroni M;Ippolito G; ;
{Journal}: Int J Infect Dis
{Volume}: 14
{Issue}: 0
{Year}: Oct 2010
{Factor}: 12.074
{DOI}: 10.1016/j.ijid.2010.05.008
{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.