SCCM Resource Library-Hospital-Acquired/Ventilator-Associated Bacterial Pneumonia: Strategies for Early Effective Therapy in Critically Ill Patients - This program is supported by an educational grant from AbbVie Inc and Merck Sharp & Dohme LLC.

Video Transcription

All right, welcome, thank you for joining us and for your patients, we were just wanting to sync up with our online audience.  So this is, today's talk is Hospital-Associated Bacterial Pneumonia, Ventilator-Associated  Bacterial Pneumonia, Strategies for Early Effective Therapy in our Critically Ill Patients. We have an online audience joining us as well today, so we'd like to welcome them.  It is an honor to be here today and to be asked by SIDP, Society of Infectious Diseases Pharmacists to speak, along with ProCE and then in partnership with SCCM to put on today's  discussion. This event is made possible by an educational grant from Abbey and also Merck, Sharp, and Dome.  I'd also like to thank Dr. Jacqueline Meredith for helping oversee this and merge together lecture slides from two speakers.  We are going to be doing a lot of audience participation, audience polling, so you should have a QR code near you for those in the room.  You can join using PollNV, so it's PollNV.com, CCO Polling. For those of you joining us online, you will also be able to vote along with the questions.  A poll will actually pop up on your screen, and you'll be able to click on your answer. Unanswered polls are going to remain on your screen, and they will not go away.  You can also submit questions various ways. For those of you online, there will be a question box, and you can put your question in that way.  I think there are some cards that are kind of spread out through the room, if you'd like to submit a question on a card.  And again, at the end, we'll have the microphones open for you to join us with any questions. My name is Monica Donnelly.  I'm an infectious diseases pharmacist at the University of California, Davis Health. And I'd like to introduce and thank Dr. Christian Sandrock for agreeing to do this talk with  me today.  Dr. Sandrock is vice chair for inpatient care, associate chief medical officer. He's with the Department of Pulmonary and Critical Care Sleep Medicine.  And fun fact, he was an ID fellow before he went into critical care medicine. I think we have disclosures have been kind of circulating as we've been going.  We're going to start testing out our polling. So the first ones are just to get some demographics of who's joining us today.  And we will just have you come in with, if you are in practice, what is your degree type? A, nurse. B, nurse practitioner. C, pharmacist. D, physician. E, physician assistant.  Or F, other health care professional.  All right.  Okay. Next. And again, for demographics. For those of you providing patient care, how many patients with pneumonia do you typically care for in a week? A, 1 to 10. B, 11 to 25.  C, 26 to 50. D, 51 to 100. Or E, greater than 100.  All right. Thank you for that. All right. Moving into our pre-test questions. And we're going to cover this material throughout the talk.  Oh, we're going to go back, if we can, sorry. So pre-survey question number one in a study by Castanera and colleagues.  Knowing KPCs, which resistance mechanism is the most common for causing carbapenem resistance in the United States? Is it A, SEM beta-lactamase? B, metallobeta-lactamase?  C, OXA48-like beta-lactamase? D, CRE without carbapenemase? Or E, I'm unsure.  All right. So, pretty good mix there. Couple in the lead. OXA not far behind. All right. We'll get into that stuff. Pre-survey question number two. Which mnemonic would help you  predict clinically relevant AMP C production? A, heck yes. B, my space. C, space. D, spice. Or E, I'm unsure.  Oh, I can see the results coming in. That's great. Lots of participation.  Almost 250 results. Okay, we can move on forward. All right, good, we got some information to cover here. Nobody, 3% with MySpace, all right.  So the next two questions, we'll refer back to this case.  So we have a 56-year-old patient who's presenting from a skilled nursing facility with COVID. His ICU hospital course has been complicated by ECLS therapy, AKI on CRRT,  respiratory failure with multiple episodes of a ventilator-associated bacterial pneumonia. Previous cultures have grown DTR pseudomonas aeruginosa,  resistant to multiple agents, including carbapenems. On hospital day 67, he develops hypoxic respiratory failure.  He's febrile. He has a right lower lobe infiltrate on chest X-ray, and he's empirically on ceftolazine tezobactam.  So question three, on rounds, your team asks you for other treatment options for DTR pseudomonas aeruginosa. If you're following the IDSA guidelines,  what would be your preferred options? A, ceftazidime AV bactam only, B, meropenem vabor bactam only, C, imipenem cilostatin relobactam only,  or D, ceftazidime AV bactam or meropenem vabor bactam, E, ceftazidime AV bactam or imipenem cilostatin relobactam, F, meropenem vabor bactam or imipenem cilostatin relobactam,  or G, I'm unsure, and I'm really good at tongue twisters.  Okay, great, good mix there, D and G followed by E and F, fantastic, okay, one more. One more pre-test question.  When optimizing antimicrobial dosing for patients on extracorporeal life support, it is important  to consider, A, increased drug sequestration of lipophilic drugs, B, decreased drug sequestration  of drugs with high protein binding, C, drug clearance due to renal and hepatic hyperperfusion, D, decreased volume of distribution due to removal of the extracorporeal volume, or E,  I am unsure.  All right, we'll go ahead and move on forward.  Okay, great.  We've got top three responses there, excellent.  Okay, to start off our material for today, we're going to cover key concepts in antimicrobial resistance and risk stratification of your patients.  Hospital-acquired and ventilator-associated bacterial pneumonia, and we're gonna go case-based. We'll go over multidrug-resistant enterobacterioles  and difficult-to-treat resistant Pseudomonas aeruginosa. And since Dr. Sandrock and I are gonna be just going back and forth, back and forth, I'm gonna ask your permission  if we can just continue the talk from the table. So we'll move over there.  All right. Good.  By the way, it was really good. I thought I'd start out by presenting all the questions because it's a bit of a weird way to say it. If I have a lot of questions like that,  I don't know what to do with it, so I just generally push from the wall and throw them into the table. It was nice that she started. She laid it out very well.  You couldn't find anything out about that.  The other is improvement. I'd like to see some level of improvement, or if they're not improving, there's an alternative reason they're not improving.  So, we depend on that, and it's very difficult when they're improving.  Great question, because it was a lot of transparency.

Asset Subtitle

Pulmonary, 2023

Asset Caption

Type: cme symposia | Hospital-Acquired/Ventilator-Associated Bacterial Pneumonia: Strategies for Early Effective Therapy in Critically Ill Patients - This program is supported by an educational grant from AbbVie Inc and Merck Sharp & Dohme LLC. (SessionID 499001)

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Membership Level Professional

Membership Level Select

Tag Pneumonia

Tag Ventilator Associated Pneumonia VAP

Year 2023

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