2016年IDSA医院获得性肺炎和呼吸机相关性肺炎诊断和治疗指南

ClinicalInfectiousDiseasesIDSAGUIDELINEManagementofAdultsWithHospital-acquiredandVentilator-associatedPneumonia:2016ClinicalPracticeGuidelinesbytheInfectiousDiseasesSocietyofAmericaandtheAmericanThoracicSocietyAndreC.Kalil,1,aMarkL.Metersky,2,aMichaelKlompas,3,4JohnMuscedere,5DanielA.Sweeney,6LucyB.Palmer,7LenaM.Napolitano,8NaomiP.O’Grady,9JohnG.Bartlett,10JordiCarratalà,11AliA.ElSolh,12SantiagoEwig,13PaulD.Fey,14ThomasM.FileJr,15MarcosI.Restrepo,16JasonA.Roberts,17,18GrantW.Waterer,19PeggyCruse,20ShandraL.Knight,20andJanL.Brozek211DepartmentofInternalMedicine,DivisionofInfectiousDiseases,UniversityofNebraskaMedicalCenter,Omaha;2DivisionofPulmonaryandCriticalCareMedicine,UniversityofConnecticutSchoolofMedicine,Farmington;3BrighamandWomen’sHospitalandHarvardMedicalSchool,and4HarvardPilgrimHealthCareInstitute,Boston,Massachusetts;5DepartmentofMedicine,CriticalCareProgram,QueensUniversity,Kingston,Ontario,Canada;6DivisionofPulmonary,CriticalCareandSleepMedicine,UniversityofCalifornia,SanDiego;7DepartmentofMedicine,DivisionofPulmonaryCriticalCareandSleepMedicine,StateUniversityofNewYorkatStonyBrook;8DepartmentofSurgery,DivisionofTrauma,CriticalCareandEmergencySurgery,UniversityofMichigan,AnnArbor;9DepartmentofCriticalCareMedicine,NationalInstitutesofHealth,Bethesda,and10JohnsHopkinsUniversitySchoolofMedicine,Baltimore,Maryland;11DepartmentofInfectiousDiseases,HospitalUniversitarideBellvitge,BellvitgeBiomedicalResearchInstitute,SpanishNetworkforResearchinInfectiousDiseases,UniversityofBarcelona,Spain;12DepartmentofMedicine,DivisionofPulmonary,CriticalCareandSleepMedicine,UniversityatBuffalo,VeteransAffairsWesternNewYorkHealthcareSystem,NewYork;13ThoraxzentrumRuhrgebiet,DepartmentofRespiratoryandInfectiousDiseases,EVKHerneandAugusta-Kranken-AnstaltBochum,Germany;14DepartmentofPathologyandMicrobiology,UniversityofNebraskaMedicalCenter,Omaha;15SummaHealthSystem,Akron,Ohio;16DepartmentofMedicine,DivisionofPulmonaryandCriticalCareMedicine,SouthTexasVeteransHealthCareSystemandUniversityofTexasHealthScienceCenteratSanAntonio;17Burns,TraumaandCriticalCareResearchCentre,TheUniversityofQueensland,18RoyalBrisbaneandWomen’sHospital,Queensland,and19SchoolofMedicineandPharmacology,UniversityofWesternAustralia,Perth,Australia;20LibraryandKnowledgeServices,NationalJewishHealth,Denver,Colorado;and21DepartmentofClinicalEpidemiologyandBiostatisticsandDepartmentofMedicine,McMasterUniversity,Hamilton,Ontario,CanadaItisimportanttorealizethatguidelinescannotalwaysaccountforindividualvariationamongpatients.Theyarenotintendedtosupplantphysicianjudgmentwithrespecttoparticularpatientsorspecialclinicalsituations.IDSAconsidersadherencetotheseguidelinestobevoluntary,withtheultimatedeterminationregardingtheirapplicationtobemadebythephysicianinthelightofeachpatient’sindividualcircumstances.Theseguidelinesareintendedforusebyhealthcareprofessionalswhocareforpatientsatriskforhospital-acquiredpneumonia(HAP)andventilator-associatedpneumonia(VAP),includingspecialistsininfectiousdiseases,pulmonarydiseases,criticalcare,andsurgeons,anesthesiologists,hospitalists,andanycliniciansandhealthcareproviderscaringforhospitalizedpatientswithnosocomialpneumonia.Thepanel’srecommendationsforthediagnosisandtreatmentofHAPandVAParebaseduponevidencederivedfromtopic-specificsystematicliteraturereviews.EXECUTIVESUMMARYInthis2016guideline,theterm“hospital-acquiredpneumo-nia”(HAP)denotesanepisodeofpneumonianotassociatedwithmechanicalventilation.Thus,patientswithHAPandventilator-associatedpneumonia(VAP)belongto2distinctgroups.Themajordifferencesbetweenthisguidelineandthe2005version[1]includethefollowing:theuseoftheGradingofRecommendationsAssessment,DevelopmentandEvaluation(GRADE)methodologyfortheevaluationofallavailableevidence(Table1)[2];theremovaloftheconceptofhealthcare-associatedpneumonia(HCAP);andtherecom-mendationthateachhospitalgenerateantibiogramstoguidehealthcareprofessionalswithrespecttotheoptimalchoiceofantibiotics.Inanefforttominimizepatientharmandexpo-suretounnecessaryantibioticsandreducethedevelopmentofantibioticresistance,werecommendthattheantibiogramdatabeutilizedtodecreasetheunnecessaryuseofdualgram-negativeandempiricmethicillin-resistantStaphylococ-cusaureus(MRSA)antibiotictreatment.Wealsorecommendshort-courseantibiotictherapyformostpatientswithHAPorVAPindependentofmicrobialetiology,aswellasantibioticde-escalation.Summarizedbelowaretherecommendationsmadeinthe2016guideline.Adetaileddescriptionofthemethods,background,andevidencesummariesthatsupporteachoftherecommendationscanbefoundinthefulltextofthisguideline.Received17May2016;accepted18May2016.aA.C.K.andM.L.M.contributedequallytothiswork.Correspondence:A.C.Kalil,DepartmentofInternalMedicine,DivisionofInfectiousDiseas-es,UniversityofNebraskaMedicalCenter,Omaha,NE68198-5400([e-mail]).ClinicalInfectiousDiseases®2016;63(5):575–82©TheAuthor2016.PublishedbyOxfordUniversityPressfortheInfectiousDiseasesSocietyofAmerica.Allrightsreserved.Forpermissions,[e-mail]:10.1093/cid/ciw504