Abstract
Nosocomial pneumonia (NP), including hospital-acquired pneumonia in non-intubated patients and ventilator-associated pneumonia, is one of the most frequent hospital-acquired infections, especially in the intensive care unit. NP has a significant impact on morbidity, mortality and health care costs, especially when the implicated pathogens are multidrug-resistant ones. This narrative review aims to critically review what is new in the field of NP, specifically, diagnosis and antibiotic treatment. Regarding novel imaging modalities, the current role of lung ultrasound and low radiation computed tomography are discussed, while regarding etiological diagnosis, recent developments in rapid microbiological confirmation, such as syndromic rapid multiplex Polymerase Chain Reaction panels are presented and compared with conventional cultures. Additionally, the volatile compounds/electronic nose, a promising diagnostic tool for the future is briefly presented. With respect to NP management, antibiotics approved for the indication of NP during the last decade are discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.
Highlights
Nosocomial pneumonia (NP), comprising of hospital-acquired (HAP) and ventilatorassociated pneumonia (VAP), is one of the most common nosocomial infections in the intensive care unit (ICU) and is responsible for more than half of antibiotics prescribed in the critical care settings [1,2]
Normal presence of fluid in the lung parenchyma, as it occurs in pneumonia and other conditions, generates an air-fluid interface which is responsible for beam-like hyperechoic vertical artefacts arising from the pleural line (B-lines)
Ab5 of 39 normal presence of fluid in the lung parenchyma, as it occurs in pneumonia and other conditions, generates an air-fluid interface which is responsible for beam-like hyperechoic vertical artefacts arising from the pleural line (B-lines)
Summary
Nosocomial pneumonia (NP), comprising of hospital-acquired (HAP) and ventilatorassociated pneumonia (VAP), is one of the most common nosocomial infections in the intensive care unit (ICU) and is responsible for more than half of antibiotics prescribed in the critical care settings [1,2]. VAP, HAP is associated with serious complications, especially when it develops in the ICU, including pleural effusions, respiratory and renal failure, septic shock and empyema in approximately 50% of the patients [2,7,10]. Traditional pathogen-identifying methods such as the culture-based techniques, that currently represent the gold standard in microbiological diagnosis are time consuming, requiring approximately 48–72 h before results are available [17]. This underscores an unmet need for rapid and reliable molecular tests leading to a shift from empirical to targeted antimicrobial therapy and, better clinical outcomes and less antibiotic overuse [17]. Regarding updates in NP management, antibiotics that have been approved during the last decade for the indication of NP will be discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam and meropenem/vaborbactam [18,19]
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