Impact of hospital-acquired pneumonia (HAP) guidelines on outcome

Hospital-acquired pneumonia (HAP) associated with mechanical ventilation complicates the course of patients in the intensive care unit (ICU), prolongs hospital stay, and increases the risk of death. Despite extensive clinical experience with this disease, controversies still exist regarding epidemiologic patterns and optimal management strategies, including empiric antibiotic therapy. Empiric broad-spectrum treatment is commonly used based on the prevalence of local pathogens, their antibiotic sensitivity pattern, and on host factors. The seriousness of HAP and the varied and polymicrobial nature of the etiologic agents coupled with diagnostic problems led to the development of evidence-based guidelines for initial empiric treatment. Guidelines on HAP facilitates comprehension and the knowledge required for optimizing the management of this complex condition, allows the interpretation of the different recommendations included in the guidelines according to the level of evidence supporting each statement, offers homogeneous definitions of HAP and groups at risk, and favors decisions regarding adequate antimicrobial therapy. Protocolized treatment guidelines, however, should be adapted to local epidemiologic and microbiologic data, including markers of multiresistance, antimicrobial agents approved in each country, and antibiotics included in the protocols of individual hospitals or services. Implementation of guidelines on HAP in daily practice requires extensive institutional support, design of effective campaigns for the diffusion of guidelines to all professionals involved in the day-to-day care of these critically ill patients, and sufficient resources for the monitoring of adherence to guidelines and assessment of the impact of guidelines on indicators of the quality of care. © 2007 Lippincott Williams & Wilkins, Inc.