Nosocomial Pneumonia in the ICU— Year 2000 and Beyond

• Published in: Chest Vol. 115; no. 3; pp. 28S - 33S
• Main Author: Bowton, David L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.1999; American College of Chest Physicians
• Subjects: Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; antibiotic regimen; Antibiotics; Catheters; Clinical Trials as Topic; Combined Modality Therapy; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - mortality; culture; Humans; Intensive Care Units; Mortality; Nosocomial infections; Pathogens; Patient Care Team; Patients; Pneumonia; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - mortality; Survival Rate; ventilator-associated pneumonia; Ventilators; Ventilators, Mechanical; Virulence; HME; VAP; CTAZ; culture; MIC; antibiotic regimen; ventilator-associated pneumonia; PIP/TAZO; PCB
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.115.suppl_1.28S

Diagnostic and treatment strategies in ICU patients with ventilator-associated pneumonia (VAP) remain controversial, largely because of the paucity of well-controlled comparison trials using clinically important end points. Recent studies indicating that early appropriate antibiotic therapy significantly lowers mortality underscore the urgent need for well-designed comparative trials. When quantitatively cultured, bronchial specimens obtained by noninvasive techniques may provide clinically useful information and avoid the higher costs and risks of invasive bronchoscopic diagnostic techniques. Previous antibiotic use before onset of nosocomial pneumonia raises the likelihood of infection with highly virulent organisms, such as Pseudomonas aeruginosa and Acinetobacter sp. Thus, the empiric antibiotic regimen should be active against these Gram-negative pathogens as well as other common Gram-negative and Gram-positive causative organisms. Promising preventive modalities for nosocomial VAP include use of a semirecumbent position, endotracheal tubes that allow continuous aspiration of secretions, and heat and moisture exchangers. Rotating their standard empiric antibiotic regimens and restricting the use of third-generation cephalosporins as empiric therapy may help hospitals reduce the incidence of nosocomial pneumonia caused by resistant Gram-negative pathogens.