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 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.
Borgatta and Rello (2014) performed a Pubmed search of articles addressing the management of ventilator-associated pneumonia (VAP). Immunocompromised patients, children and VAP due to multidrug-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.
The researchers say it is 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. Their research was published in BMC Infectious Diseases.
Reference: Borgatta B and Rello J. How to approach and treat VAP in ICU patients. BMC Infectious Diseases 2014, 14:211.