Raj Nikhil, Nath Soumya S, Singh Vikramjeet, Agarwal Jyotsna
Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Anesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Crit Care Med. 2024 Oct;28(10):908-911. doi: 10.5005/jp-journals-10071-24812. Epub 2024 Sep 30.
The recently formulated guidelines by Khilnani GC et al. for the prescription of antibiotics for critically ill patients present an extensive compilation of evidence and recommendations. Despite their comprehensive nature, several inconsistencies need addressing. In this commentary, we delve into some of these discrepancies in the order in which they appeared in the guidelines, starting with the misrepresentation of "nonbronchoscopic bronchoalveolar lavage (BAL)" and "mini BAL" as different techniques when they are, in fact, identical. Secondly, the Centers for Disease Control and Prevention (CDC) in the year 2013 replaced the older, unreliable ventilator-associated pneumonia (VAP) definition with ventilator-associated events (VAE). This new VAE definition eliminates subjectivity in pneumonia diagnosis by focusing on objective criteria for ventilator support changes, avoiding dependence on potentially inaccurate chest X-rays and inconsistent medical record keeping. Thus, using the term VAP in the Indian guidelines seems regressive. Furthermore, the recommendation for routine anaerobic coverage in aspiration pneumonia is outdated and unsupported by current evidence. Lastly, while endorsing multiplex polymerase chain reaction (PCR) for pathogen identification, the guidelines fail to adequately address its limitations and the risk of overdiagnosis.
Raj N, Nath SS, Singh V, Agarwal J. Inconsistencies in the Indian Guidelines for the Prescription of Antibiotics for Critically Ill Patients. Indian J Crit Care Med 2024;28(10):908-911.
Khilnani GC等人最近为重症患者制定的抗生素处方指南汇集了大量证据和建议。尽管内容全面，但仍有一些不一致之处需要解决。在这篇评论中，我们深入探讨指南中出现的一些差异，首先是将“非支气管镜下支气管肺泡灌洗（BAL）”和“微型BAL”错误表述为不同技术，而实际上它们是相同的。其次，疾病控制与预防中心（CDC）在2013年用呼吸机相关事件（VAE）取代了旧的、不可靠的呼吸机相关性肺炎（VAP）定义。这个新的VAE定义通过关注呼吸机支持变化的客观标准消除了肺炎诊断中的主观性，避免了对可能不准确的胸部X线检查和不一致的病历记录的依赖。因此，在印度指南中使用VAP这个术语似乎是一种倒退。此外，对于吸入性肺炎常规进行厌氧菌覆盖的建议已经过时，且没有当前证据支持。最后，虽然认可多重聚合酶链反应（PCR）用于病原体鉴定，但指南未能充分解决其局限性和过度诊断的风险。
Raj N, Nath SS, Singh V, Agarwal J. 印度重症患者抗生素处方指南中的不一致之处。《印度重症监护医学杂志》2024；28(10):908 - 911。
