Hospital-acquired Pneumonia and Ventilator-associated Pneumonia

Recent Advances in Epidemiology and Management

François Barbier; Antoine Andremont; Michel Wolff; Lila Bouadma

Disclosures

Curr Opin Pulm Med. 2013;19(3):216-228. 

In This Article

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.

Introduction

Hospital-acquired pneumonia (HAP) is a pulmonary infection that develops in patients hospitalized for more than 48 h, either in the ICU or in other wards.[1,2] Ventilator-associated pneumonia (VAP), a subset of HAP that occurs in mechanically ventilated patients more than 48 h after tracheal intubation, is the most frequent ventilator-associated complication (VAC).[1,2] HAP/VAP represents a major cause of deaths, morbidity and resources utilization in hospitalized patients, most notably in those with severe underlying conditions.[1,3,4,5,6,7] The adequacy of empirical antimicrobial therapy is strongly predictive of hospital survival,[3] making the definition of patients at risk for multidrug-resistant (MDR) pathogens a pivotal challenge.[1,8–10] In this short review, we summarize the recently published data on clinical epidemiology, trends in bacterial resistance, diagnostic methods and therapeutic strategies in HAP, with a special focus on VAP.

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