Nosocomial tracheobronchitis

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Nosocomial tracheobronchitis is common among intubated critically ill patients. Ventilator-associated tracheobronchitis (VAT) represents an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia. The aim of this review is to discuss recent findings on VAT. VAT is defined using all the following criteria: fever (>38 degrees C) with no other recognizable cause, purulent sputum production, positive culture of respiratory specimen at significant threshold, and no radiographic signs of new pneumonia. This infection is frequently caused by Pseudomonas aeruginosa and characterized by lower respiratory tract inflammation and increased sputum production resulting in weaning difficulties and longer duration of mechanical ventilation. The effect of aerosolized antibiotics on outcomes in VAT patients was evaluated in a randomized blinded placebo-controlled trial. Aerosolized antibiotics significantly increased weaning from mechanical ventilation and reduced subsequent ventilator-associated pneumonia and usage of systemic antibiotics and antibiotic resistance. A randomized unblinded controlled study assessed the impact of systemic antibiotics on outcome of VAT patients. Antibiotic treatment increased mechanical ventilation-free days and reduced the incidence of subsequent ventilator-associated pneumonia and ICU mortality. Antibiotic treatment is beneficial in VAT patients. Future studies should confirm these promising results and determine the best duration of antimicrobial therapy in these patients.