Abstract
Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a meta-analysis have reported antibiotic treatment for VAT can reduce VAP, ventilator days, length of intensive care unit (ICU) stay, and patient morbidity and mortality. We discuss early diagnostic criteria, etiologic agents, and benefits of initiating, early, appropriate intravenous or aerosolized antibiotic(s) to treat VAT and reduce VAP, to improve patient outcomes by reducing lung damage, length of ICU stay, and healthcare costs.
Highlights
Ventilator-associated respiratory infections (VARI) often begin with bacterial colonization that may progress to include ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) diagnosed after 48 h of intubation [1,2,3,4,5,6,7,8,9,10]
VAT is an unappreciated but important early clinical condition in ventilated patients which has been linked to VAP, resulting in significant patient morbidity and mortality [3,4,5,6,7]
We recommend use of VAP prevention strategies with a focus on earlier diagnosis and use of preemptive, appropriate antibiotic therapy based on clinical signs and microbiologic evidence of heavy endotracheal colonization, VAT, or VAP
Summary
Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: “thinking outside the box”.
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