Hospital-acquired pneumonia: risk factors, clinical features, management, and antibiotic resistance.

Abstract

The aim of this review is to summarize recent developments regarding risks factors, clinical features, management and antimicrobial resistance, and prevention of hospital-acquired pneumonia. Risk factors for hospital-acquired pneumonia developing in specific ICUs (neurologic and cardiovascular surgery) were reported. Characteristics of pneumonia acquired in general wards but requiring ICU admission were studied. Analysis of the impact of reintubation on pneumonia occurrence demonstrated that only reintubation after accidental extubation increases the risk. Early administration of adequate antibiotic(s), associated with a deescalating strategy, remains the only measure directly amenable to modification by clinicians that decreases the infection-related mortality. Numerous data emphasized the recommendation that guidelines for hospital-acquired pneumonia therapy should be updated and customized to local patterns to improve the level of adequacy of antimicrobial treatment. A 8-day treatment regimen could be proposed when pneumonia is not caused by a nonfermenting, gram-negative bacilli. In cases of pneumonia caused by methicillin-resistant Staphylococcus aureus, linezolid, compared with vancomycin, significantly increases the rates of cure and survival. Semirecumbent positioning in all eligible patients, sucralfate rather than H2 antagonists in patients at low to moderate risk of gastrointestinal bleeding, and, in selected patients, aspiration of subglottic secretions and oscillating beds are the measures proposed to prevent the development of ventilator-associated pneumonia. Conversely, the routine or indiscriminate use of selective digestive decontamination is not recommended. In our opinion, the optimization of the length of treatment and the reduction of mortality with linezolid in staphylococcal pneumonia are two major recent developments.