Drug Prevention and Control of Ventilator-Associated Pneumonia.

Xinming Xie,Tafseel Hussain,Manxiang Li,Jun Lyu

doi:10.3389/fphar.2019.00298

Abstract

Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.

Highlights

Ventilator-associated pneumonia (VAP) is believed to be the most commonly acquired infection in the intensive care unit (ICU) and is associated with high morbidity and mortality rates (Timsit et al, 2017a; Vandana Kalwaje and Rello, 2018)
It is important that the antimicrobial therapy be right in the first time in VAP patients, because the pathogens associated with inappropriate initial therapy are usually antibiotic-resistant strains of these pathogens, so patients at high risk of infection with these organisms initially needed to receive a combination of agents providing a very broad spectrum of coverage (Weiner et al, 2016; Rhodes et al, 2018)
A recent meta-analysis of 20 randomized controlled trials (RCTs) performed by Mao et al (2016) suggested that subglottic suctioning reduced the risk for VAP by 45% compared to the control group, and subglottic secretion suction was recommended for preventing VAP and for reducing ventilation

Summary

Introduction

Ventilator-associated pneumonia (VAP) is believed to be the most commonly acquired infection in the intensive care unit (ICU) and is associated with high morbidity and mortality rates (Timsit et al, 2017a; Vandana Kalwaje and Rello, 2018). A prevention policy aiming to reduce VAP remains an important element of the management for patients admitted to ICUs and requiring mechanical ventilation. It is important that the antimicrobial therapy be right in the first time in VAP patients, because the pathogens associated with inappropriate initial therapy are usually antibiotic-resistant strains of these pathogens, so patients at high risk of infection with these organisms initially needed to receive a combination of agents providing a very broad spectrum of coverage (Weiner et al, 2016; Rhodes et al, 2018).

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