[Solved]: Some of the key recommendations and principles in…

Some of the key recommendations and principles in this new, evidence-based guideline are as follows: HCAP is included in the spectrum of HAP and VAP, and patients with HCAP need therapy for MDR pathogens. A lower respiratory tract culture needs to be collected from all patients before antibiotic therapy, but collection of cultures should not delay the initiation of therapy in critically ill patients. Either semiquantitative or quantitative culture data can be used for the management of patients with HAP. Lower respiratory tract cultures can be obtained bronchoscopically or nonbronchoscopically, and can be cultured quantitatively or semiquantitatively. Quantitative cultures increase specificity of the diagnosis of HAP without deleterious consequences, and the specific quantitative technique should be chosen on the basis of local expertise and experience. Negative lower respiratory tract cultures can be used to stop antibiotic therapy in a patient who has had cultures obtained in the absence of an antibiotic change in the past 72 hours. Early, appropriate, broad-spectrum, antibiotic therapy should be prescribed with adequate doses to optimize antimicrobial efficacy. An empiric therapy regimen should include agents that are from a different antibiotic class than the patient has recently received. Combination therapy for a specific pathogen should be used judiciously in the therapy of HAP, and consideration should be given to short-duration (5 days) aminoglycoside therapy, when used in combination with a -lactam to treat P. aeruginosa pneumonia. Linezolid is an alternative to vancomycin, and unconfirmed, preliminary data suggest it may have an advantage for proven VAP due to methicillin-resistant S. aureus. Colistin should be considered as therapy for patients with VAP due to a carbapenem-resistant Acinetobacter species. Aerosolized antibiotics may have value as adjunctive therapy in patients with VAP due to some MDR pathogens. De-escalation of antibiotics should be considered once data are available on the results of lower respiratory tract cultures and the patient’s clinical response. A shorter duration of antibiotic therapy (7 to 8 days) is recommended for patients with uncomplicated HAP, VAP, or HCAP who have received initially appropriate therapy and have had a good clinical response, with no evidence of infection with nonfermenting gram-negative bacilli. Summarize above in fewer sentences