***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective , after adjusting for potential confounders . Design Patients admitted between January 19 , 1998 , and December 31 , 1999 , were followed prospect ively for the occurrence of ventilator-associated pneumonia . Hospital costs were defined by using the hospital cost accounting data base . Setting The medical and surgical intensive care units at a suburban , tertiary care hospital . Patients Patients requiring > 24 hrs of mechanical ventilation . Interventions None . Measurements and Main Results We measured occurrence of ventilator-associated pneumonia , in-hospital mortality rate , total intensive care unit ( ICU ) and hospital lengths of stay ( LOS ) , and total hospital cost per patient . Ventilator-associated pneumonia occurred in 127 of 819 patients ( 15.5 % ) . Compared with uninfected , ventilated patients , patients with ventilator-associated pneumonia had a higher Acute Physiology and Chronic Health Evaluation II score on admission ( p < .001 ) and were more likely to require multiple intubations ( p < .001 ) , hemodialysis ( p < .001 ) , tracheostomy ( p < .001 ) , central venous catheters ( p < .001 ) , and corticosteroids ( p < .001 ) . Patients with ventilator-associated pneumonia were more likely to be bacteremic during their ICU stay ( 36 [ 28 % ] vs. 22 [3%];p < .001 ) . Patients with ventilator-associated pneumonia had significantly higher unadjusted ICU LOS ( 26 vs. 4 days;p < .001 ) , hospital LOS ( 38 vs. 13 days;p < .001 ) , mortality rate ( 64 [ 50 % ] vs. 237 [34%];p < .001 ) , and hospital costs ( $ 70,568 vs. $ 21,620 , p < .001 ) . Multiple linear regression , controlling for other factors that may affect costs , estimated the attributable cost of ventilator-associated pneumonia to be $ 11,897 ( 95 % confidence interval = $ 5,265–$26,214;p < .001 ) . Conclusions Patients with ventilator-associated pneumonia had significantly longer ICU and hospital LOS , with higher crude hospital cost and mortality rate compared with uninfected patients . After we adjusted for underlying severity of illness , the attributable cost of ventilator-associated pneumonia was approximately $ 11,897 BACKGROUND Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units . We aim ed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting . METHODS In this multicentre , prospect i ve , parallel-group , open-label trial , we used an independent , computer-generated r and omisation sequence to r and omly assign patients in a 1:1 ratio to procalcitonin ( n=311 patients ) or control ( n=319 ) groups ; investigators were masked to assignment before , but not after , r and omisation . For the procalcitonin group , antibiotics were started or stopped based on predefined cut-off ranges of procalcitonin concentrations ; the control group received antibiotics according to present guidelines . Drug selection and the final decision to start or stop antibiotics were at the discretion of the physician . Patients were expected to stay in the intensive care unit for more than 3 days , had suspected bacterial infections , and were aged 18 years or older . Primary endpoints were mortality at days 28 and 60 ( non-inferiority analysis ) , and number of days without antibiotics by day 28 ( superiority analysis ) . Analyses were by intention to treat . The margin of non-inferiority was 10 % . This trial is registered with Clinical Trials.gov , number NCT00472667 . FINDINGS Nine patients were excluded from the study ; 307 patients in the procalcitonin group and 314 in the control group were included in analyses .  Mortality of patients in the procalcitonin group seemed to be non-inferior to those in the control group at day 28 ( 21.2 % [ 65/307 ] vs 20.4 % [ 64/314 ] ; absolute difference 0.8 % , 90 % CI -4.6 to 6.2 ) and day 60 ( 30.0 % [ 92/307 ] vs 26.1 % [ 82/314 ] ; 3.8 % , -2.1 to 9.7 ) . Patients in the procalcitonin group had significantly more days without antibiotics than did those in the control group ( 14.3 days [ SD 9.1 ] vs 11.6 days [ SD 8.2 ] ; absolute difference 2.7 days , 95 % CI 1.4 to 4.1 , p<0.0001 ) . INTERPRETATION A procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes . FUNDING Assistance Publique-Hôpitaux de Paris , France , and Brahms , Germany STUDY OBJECTIVE To determine whether the development of late-onset ventilator-associated pneumonia ( VAP ) is associated with an increased risk of hospital mortality . DESIGN Prospect i ve cohort study . SETTING ICUs of two university-affiliated teaching hospitals . PATIENTS Three hundred fourteen patients admitted to an ICU who required mechanical ventilation for greater than 5 days . INTERVENTIONS Prospect i ve patient surveillance and data collection . MEASUREMENTS The primary outcome measures were the development of late-onset VAP ( ie , occurring > 96 h after intubation ) and hospital mortality . RESULTS Late-onset VAP was observed in 87 patients ( 27.7 % ) . Thirty-four ( 39.1 % ) patients with late-onset VAP died during hospitalization compared with 85 patients ( 37.4 % ) without late-onset VAP ( relative risk , 1.04 ; 95 % confidence interval [ CI ] , 0.76 to 1.43 ) . Twenty patients ( 6.4 % ) developed late-onset VAP due to a " high-risk " pathogen ( ie , Pseudomonas aeruginosa , Acinetobacter sp , Xanthomonas maltophilia ) with an associated mortality rate of 65 % . Stepwise logistic regression analysis identified five variables as independent risk factors for hospital mortality ( p < 0.05 ) : an organ system failure index of 3 or greater ( adjusted odds ratio [ AOR ] , 3.4 ; 95 % CI , 2.0 to 5.8 ; p < 0.001 ) , having a nonsurgical diagnosis ( AOR , 2.1 ; 95 % CI , 1.3 to 3.6 ; p = 0.002 ) , a premorbid lifestyle score of 2 or greater ( AOR , 1.8 ; 95 % CI , 1.1 to 2.9 ; p = 0.015 ) , acquiring late-onset VAP due to a " high-risk " pathogen ( AOR , 3.4 ; 95 % CI , 1.2 to 10.0 ; p = 0.025 ) , and having received antacids or histamine type-2 receptor antagonists ( AOR , 1.7 ; 95 % CI , 1.0 to 2.9 ; p = 0.034 ) . Additionally , we found the occurrence of late-onset VAP due to high-risk pathogens to be the most important predictor of hospital mortality among patients developing VAP ( AOR , 5.4 ; 95 % CI , 2.8 to 10.3 ; p = 0.009 ) . CONCLUSIONS Nosocomial pneumonia due to certain high-risk microorganisms is an independent risk factor for hospital mortality among patients requiring prolonged mechanical ventilation . We suggest that future investigations of late-onset VAP stratify patient outcomes according to the distribution of high-risk pathogens when reporting their results Objective : To investigate the frequency and outcomes of ventilated patients with newly acquired large burdens of Pseudomonas aeruginosa and to test the hypothesis that large quantities of bacteria are associated with adverse patient outcomes . Design : A prospect i ve , single-center , observational , cohort study . Setting : Medical-surgical intensive care units in a tertiary care university hospital . Patients : All adult patients requiring ≥48 hrs of mechanical ventilation and identified as having newly acquired P. aeruginosa in their lower respiratory tracts between October 2002 and April 2006 . Interventions : None . Measurements and Main Results : Daily  surveillance cultures of endotracheal aspirates were performed on patients intubated ≥48 hrs ; 69 patients with newly acquired P. aeruginosa were enrolled . Daily P. aeruginosa quantification of endotracheal aspirates was performed ; clinical signs of infection were noted . Of 45 patients with high P. aeruginosa burdens ( ≥1,000,000 colony-forming units/mL in endotracheal aspirates ; ≥10,000 colony-forming units/mL in bronchoalveolar-lavage ) , 17 ( 37.8 % ) patients did not meet clinical criteria for ventilator-associated pneumonia and had a statistically significant higher risk of death ( adjusted hazard ratio , 37.53 ; 95 % confidence interval , 3.79–371.96 ; p = 0.002 ) when compared with the patients who had P. aeruginosa ventilator-associated pneumonia . When excluding the ten patients who had ventilator-associated pneumonia attributed to bacteria other than P. aeruginosa or attributed to multiple bacteria including P. aeruginosa , the risk of death remained statistically significant ( adjusted hazard ratio , 23.98 ; 95 % confidence interval : 2.49–230.53 ; p = 0.006 ) . Furthermore , more patients with high P. aeruginosa burdens secreted the type III secretion facilitator protein , PcrV ( p = 0.01 ) . Conclusions : A group of patients with large burdens of P. aeruginosa who did not meet clinical criteria for ventilator-associated pneumonia had an increased risk of death when compared with patients who had high P. aeruginosa burdens and met ventilator-associated pneumonia criteria . Patients with high P. aeruginosa burden seemed to possess more virulent strains Objective : For patients in intensive care units , sepsis is a common and potentially deadly complication and prompt initiation of appropriate antimicrobial therapy improves prognosis . The objective of this trial was to determine whether a strategy of antimicrobial spectrum escalation , guided by daily measurements of the biomarker procalcitonin , could reduce the time to appropriate therapy , thus improving survival . Design : R and omized controlled open-label trial . Setting : Nine multidisciplinary intensive care units across Denmark . Patients : A total of 1,200 critically ill patients were included after meeting the following eligibility requirements : expected intensive care unit stay of ≥24 hrs , nonpregnant , judged to not be harmed by blood sampling , bilirubin < 40 mg/dL , and triglycerides < 1000 mg/dL ( not suspensive ) . Interventions : Patients were r and omized either to the “ st and ard-of-care-only arm , ” receiving treatment according to the current international guidelines and blinded to procalcitonin levels , or to the “ procalcitonin arm , ” in which current guidelines were supplemented with a drug-escalation algorithm and intensified diagnostics based on daily procalcitonin measurements . Measurements and Main Results : The primary end point was death from any cause at day 28 ; this occurred for 31.5 % ( 190 of 604 ) patients in the procalcitonin arm and for 32.0 % ( 191 of 596 ) patients in the st and ard-of-care-only arm ( absolute risk reduction , 0.6 % ; 95 % confidence interval [ CI ] −4.7 % to 5.9 % ) . Length of stay in the intensive care unit was increased by one day ( p = .004 ) in the procalcitonin arm , the rate of mechanical ventilation per day in the intensive care unit increased 4.9 % ( 95 % CI , 3.0–6.7 % ) , and the relative risk of days with estimated glomerular filtration rate < 60 mL/min/1.73 m2 was 1.21 ( 95 % CI , 1.15–1.27 ) . Conclusions : Procalcitonin-guided antimicrobial escalation in the intensive care unit did not improve survival and did lead to organ-related harm and prolonged admission to the intensive care unit . The procalcitonin strategy like the one used in this trial can not be recommended Objective To assess how data obtained by invasive diagnostic techniques may affect management and outcome of patients with suspected ventilator-associated pneumonia ( VAP ) , in comparison with noninvasive qualitative techniques . Design Prospect i ve study . Setting An 18-bed medical and surgical intensive care unit . Patients A total of 91 patients suspected of having VAP were r and omized into two groups . In group A ( n 
    Output:
    
We found no evidence relating to patients with a high probability of HAP who were not mechanically ventilated .
On the basis of a small number of studies and appreciating the lack of uniform definition of pneumonia , we conclude that for patients with VAP not due to NF-GNB a short , fixed course ( seven or eight days ) of antibiotic therapy appears not to increase the risk of adverse clinical outcomes , and may reduce the emergence of resistant organisms , compared with a prolonged course ( 10 to 15 days ) .
However , for patients with VAP due to NF-GNB , there appears to be a higher risk of recurrence following short-course therapy .
There are few data from RCTs comparing duration s of therapy in non-ventilated patients with HAP , but on the basis of a single study , short-course ( three-day ) therapy for HAP appears not to be associated with worse clinical outcome , and may reduce the risk of subsequent infection or the emergence of resistant organisms when there is low probability of pneumonia according to the CPIS