Commentary: Empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora but not the resistance profile if a subsequent pneumonia develops

Abstract

DOI of original article: 10.1016/j.jss.2012.0 * Corresponding author. Department of Surg 62008, Houston, TX 77026. Tel.: þ1 713 566 5 E-mail address: Lillian.S.Kao@uth.tmc.ed 0022-4804/$ e see front matter a 2013 Elsev http://dx.doi.org/10.1016/j.jss.2012.09.025 Ventilator-associated pneumonia (VAP), defined as pneumonia that occurs within 48e72 h of endotracheal intubation, has been reported to occur in up to 52% of critically ill patients [1]. VAP is associated with increased morbidity, mortality, the length of hospital stay, and excess costs [2]. Given the magnitude of the problem, there has been an impetus to identify processes of care that are linked to outcome such as appropriate antibiotic coverage and timing in patients with suspected VAP. In 2005, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) published the consensus guidelines for the management of VAP. The guidelines provided recommendations for the prompt initiation of antibiotic therapy, use of appropriate antibiotics with adequate coverage based on risk for multidrug-resistant (MDR) pathogens, selection of an antibiotic from an alternative class when VAP develops after prior antibiotic exposure, adaptation of antibiotic protocols to local resistance patterns, and de-escalation of antibiotics based on microbiology [3].