Abstract
Ventilator-associated pneumonia is a frequent cause of ICU-acquired infections. These infections are associated with high morbidity and mortality. The increase in antibiotic resistance, particularly among Gram-negative bacilli, makes the choice of empiric antibiotic therapy complex for physicians. Multidrug-resistant organisms (MDROs) related infections are associated with a high risk of initial therapeutic inadequacy. It is, therefore, necessary to quickly identify the bacterial species involved and their susceptibility to antibiotics. New diagnostic tools have recently been commercialized to assist in the management of these infections. Moreover, the recent enrichment of the therapeutic arsenal effective on Gram-negative bacilli raises the question of their place in the therapeutic management of these infections. Most national and international guidelines recommend limiting their use to microbiologically documented infections. However, many clinical situations and, in particular, the knowledge of digestive or respiratory carriage by MDROs should lead to the discussion of the use of these new molecules, especially the new combinations with beta-lactamase inhibitors in empirical therapy. In this review, we present the current epidemiological data, particularly in terms of MDRO, as well as the clinical and microbiological elements that may be taken into account in the discussion of empirical antibiotic therapy for patients managed for ventilator-associated pneumonia.
Highlights
Ventilator-associated pneumonia (VAP) is one of the most frequent causes of intensive care unit (ICU)-acquired infections [1]
The starting point was a retrospective cohort study based on more than 4000 patients with proven bacterial pneumonia within the 48 h following admission and transfer from a healthcare facility which showed an incidence of a quarter of admitted patients with Methicillin-Resistant Staphylococcus aureus (MRSA) infection, with the same incidence for Pseudomonas aeruginosa (PA) [14]. These findings, which led to treating community-acquired pneumonia (CAP) with risk factors of Multidrug-resistant organisms (MDROs) organisms carriage the same way as ventilator-associated pneumonia (VAP) regardless of the severity status, were later largely overruled [15]
Hospital-Acquired Pneumonia (HAP) is defined as new pneumonia in non-intubated patients, that develops more than 48 h after admission
Summary
Ventilator-associated pneumonia (VAP) is one of the most frequent causes of intensive care unit (ICU)-acquired infections [1]. By HCAP, it was meant “any patient who was hospitalized in an acute care hospital for 2 or more days within 90 days of the infection” This categorization resulted in the increasing usage of broad-spectrum antibiotics in a population which eventually appeared to be no more infected with MDRO pathogens than patients with community-acquired pneumonia (CAP) [12]. The starting point was a retrospective cohort study based on more than 4000 patients with proven bacterial pneumonia within the 48 h following admission and transfer from a healthcare facility which showed an incidence of a quarter of admitted patients with Methicillin-Resistant Staphylococcus aureus (MRSA) infection, with the same incidence for Pseudomonas aeruginosa (PA) [14] These findings, which led to treating CAP with risk factors of MDRO organisms carriage the same way as ventilator-associated pneumonia (VAP) regardless of the severity status, were later largely overruled [15]. A deeper knowledge of bacterial epidemiology stood out as the key challenge of nosocomial pneumonia management for future years
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