Hospital-acquired pneumonia and ventilator-associated pneumonia
- 1 May 2013
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Pulmonary Medicine
- Vol. 19 (3), 216-228
- https://doi.org/10.1097/mcp.0b013e32835f27be
Abstract
Purpose of review The recent evidence is reviewed on clinical epidemiology, trends in bacterial resistance, diagnostic tools and therapeutic options in hospital-acquired pneumonia (HAP), with a special focus on ventilator-associated pneumonia (VAP). Recent findings The current incidence of VAP ranges from two to 16 episodes for 1000 ventilator-days, with an attributable mortality of 3-17%. Staphylococcus aureus (with 50-80% of methicillin-resistant strains), Pseudomonas aeruginosa and Enterobacteriaceae represent the most frequent pathogens in HAP/VAP. The prevalence of carbapenemase-producing Gram-negative bacilli (GNB) and the emergence of colistin resistance are alarming. Procalcitonin seems to have a good value to monitor the response to treatment. Rapid molecular tests for the optimization of empirical therapy will be available soon. Recent studies support the use of a high-dosing regimen of colistin in HAP/VAP caused by extensively drug-resistant GNB. Linezolid may probably be preferred to vancomycin for a subset of methicillin-resistant S. aureus HAP/VAP. Given the scarcity of novel antimicrobial drugs, different approaches such as bacteriophage therapy or immunotherapy warrant further clinical evaluations. Summary HAP/VAP is a major cause of deaths, morbidity and resources utilization, notably in patients with severe underlying conditions. The development of new diagnostic tools and therapeutic weapons is urgently needed to face the epidemic of multidrug-resistant pathogens.Keywords
This publication has 148 references indexed in Scilit:
- Avibactam is a covalent, reversible, non–β-lactam β-lactamase inhibitorProceedings of the National Academy of Sciences of the United States of America, 2012
- Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-AnalysisClinical Infectious Diseases, 2012
- High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary StudyClinical Infectious Diseases, 2012
- Incidence of and Risk Factors for Colistin-Associated Nephrotoxicity in a Large Academic Health SystemClinical Infectious Diseases, 2011
- Biomarkers for ventilator-associated pneumonia: Review of the literatureHeart & Lung, 2011
- Colistin-Resistant, Klebsiella pneumoniae Carbapenemase (KPC)-Producing Klebsiella pneumoniae Belonging to the International Epidemic Clone ST258Clinical Infectious Diseases, 2011
- Are We Ready for Novel Detection Methods to Treat Respiratory Pathogens in Hospital-Acquired Pneumonia?Clinical Infectious Diseases, 2011
- Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe SepsisJama-Journal Of The American Medical Association, 2010
- Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trialThe Lancet, 2010
- Soluble Triggering Receptor Expressed on Myeloid cells-1 in bronchoalveolar lavage fluid is not predictive for ventilator-associated pneumoniaIntensive Care Medicine, 2009