Abstract
BackgroundVentilator-associated pneumonia (VAP) is one of the most frequent clinical problems in ICU with an elevated morbidity and costs associated with it, in addition to prolonged MV, ICU-length of stay (LOS) and hospital-length of stay. Current challenges in VAP management include the absence of a diagnostic gold standard; the lack of evidence regarding contamination vs. airway colonization vs. infection; and the increasing antibiotic resistance. We performed a Pubmed search of articles addressing the management of ventilator-associated pneumonia (VAP). Immunocompromised patients, children and VAP due to multi-drug resistant pathogens were excluded from the analysis. When facing a patient with VAP, it’s important to address a few key questions for the patient’s optimal management: when should antibiotics be started?; what microorganisms should be covered?; is there risk for multirresistant microorganisms?; how to choose the initial agent?; how microbiological tests determine antibiotic changes?; and lastly, which dose and for how long?. It’s important not to delay adequate treatment, since outcomes improve when empirical treatment is early and effective. We recommend short course of broad-spectrum antibiotics, followed by de-escalation when susceptibilities are available. Individualization of treatment is the key to optimal management.
Highlights
Ventilator-associated pneumonia (VAP) is one of the most frequent clinical problems in ICU with an elevated morbidity and costs associated with it, in addition to prolonged mechanical ventilation (MV), ICU-length of stay (LOS) and hospital-length of stay
Despite presenting a low attributable mortality; its burden relies on the elevated morbidity and costs associated with it, such as an estimated excess of cost as high as $40,000 per patient’s episode, in addition to prolonged MV, ICU-length of stay (LOS) and hospital-length of stay [2,5,6]
VAP represents 80% of hospital-acquired pneumonia (HAP) and is defined as pneumonia developing after 4872 h of MV
Summary
Ventilator-associated pneumonia (VAP) is one of the most frequent clinical problems in ICU. With an estimated incidence from 5–20 cases per 1.000 mechanical ventilation (MV) days; which has decreased over the last decade with the implementation of care bundles It still remains as the most frequent infection amongst critically ill patients and as the main cause of antibiotic prescription in ICU [1,2,3,4]. Current trends favor short courses of antibiotics of 7– 8 days if patient’s response is satisfying; always individualizing to resolution This approach is has equivalent clinical cure rates than long courses [30] and enables the reduction of side effects, costs and development of resistant phenotypes [3]. What’s next? Research should be directed towards the development of ultra-fast diagnostic techniques that can immediately predict causative microorganism, without the need of specimen processing and detect multirresistance mechanisms to avoid inadequate initial antibiotic treatment
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