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

New Therapeutic Approach for Ventilator-associated Pneumonia

Bacteriophages are viruses that infect bacteria in a species-specific way. In animal studies, phage therapy can both prevent and cure P. aeruginosa, Klebsiella pneumoniae and Streptococcus pneumoniae pneumonia.[146–149] These recent results may be a first basis towards further clinical trials, notably for difficult-to-treat MDR pathogens. Next, and despite an inappropriate bacterial spectrum, macrolides have immunomodulatory and anti-inflammatory effects that may be of interest in HAP/VAP.[150] A short course of clarithromycin may ease the cure of otherwise adequately treated VAP and modulate the risk of death from septic shock or multiorgan failure.[151–152] Macrolides also inhibit P. aeruginosa quorum sensing, but the clinical impact of this property remains to be confirmed.[153] Finally, in a recent RCT, monoclonal antibodies targeting the type III secretion system, a major pseudomonal virulence factor in pneumonia,[154] reduced the incidence of VAP in patients with P. aeruginosa tracheal colonization.[155] Further evaluation of immunotherapy in HAP/VAP is warranted.

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