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JAC Advance Access originally published online on May 31, 2007
Journal of Antimicrobial Chemotherapy 2007 60(2):206-213; doi:10.1093/jac/dkm176
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Hospital-acquired pneumonia guidelines in Europe: a review of their status and future development

R. Masterton1,*, D. Craven2,3, J. Rello4, M. Struelens5, N. Frimodt-Moller6, J. Chastre7, A. Ortqvist8, G. Cornaglia9, H. Lode10, H. Giamarellou11, M. J. M. Bonten12, H. Eraksoy13 and P. Davey14

1 NHS Ayrshire and Arran, Eglington House, Ailsa Hospital, Dalmellington Road, Ayr KA6 0BA, UK 2 Lahey Clinic Medical Center, Burlington, MA, USA 3 Tufts University School of Medicine, Boston, MA, USA 4 Joan XXIII University Hospital, University Rovira and Virgili, CIBERes 06-06-0036, Tarragona, Spain 5 Hôpital Erasme, Belgium 6 National Centre for Antimicrobial Infection Control, Copenhagen, Denmark 7 GH Pitié-Salpêtrière, AP-HP, Paris, France 8 Karolinska Institutet Stockholm, Stockholm, Sweden 9 University of Verona, Verona, Italy 10 City Hospital, Berlin, Germany 11 Attikon University Hospital, Athens, Greece 12 University Medical Center, Utrecht, The Netherlands 13 Istanbul University, Istanbul, Turkey 14 University of Dundee, Dundee, Scotland, UK

* Corresponding author. Tel: +44-1292-614510; Fax: +44-1292-288952; E-mail: robert.masterton{at}aaaht.scot.nhs.uk

Hospital-acquired pneumonia (HAP) is the most common healthcare-acquired infection contributing to death. Effective management requires accurate diagnosis, administration of a suitable antibiotic regimen early in infection and implementation of prevention strategies. In recent years, there has been a rapid increase in the number of country-specific HAP guidelines in Europe, which vary in their formulation, coverage of different disease aspects and overall recommendations. Development of comprehensive pan-European HAP guidelines would rationalize the conflicting proposals, provide a useful resource and limit guideline proliferation. However, careful consideration needs to be given to the principles of guideline development to ensure that the output is rigorous, broadly applicable and facilitates update as new data becomes available. The use of an evidence-based approach to HAP guideline development is optimal, but is compromised by limitations in the supporting data. The implementation of a formalized evidence grading system is key to introducing consistency into the guideline development process. Pan-European guidelines should provide recommendations on core aspects of HAP common to all treatment settings and locations, and reflect the differing perspectives of the countries involved. Given the different antibiotic susceptibility profiles across Europe, such guidelines should provide general treatment recommendations suitable for local adaptation. The development of such guidelines represents an ideal time to identify priorities for European research, by addressing controversies and identifying previously unconsidered aspects of HAP. Establishing a pan-European consensus on core processes of care should be viewed as an impetus for change to improve clinical practices and should include a suitable implementation strategy.

Keywords: European consensus , guideline development , implementation


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