Update of the Treatment of Nosocomial Pneumonia in the ICU

Rafael Zaragoza; Pablo Vidal-Cortés; Gerardo Aguilar; Marcio Borges; Emili Diaz; Ricard Ferrer; Emilio Maseda; Mercedes Nieto; Francisco Xavier Nuvials; Paula Ramirez; Alejandro Rodriguez; Cruz Soriano; Javier Veganzones; Ignacio Martín-Loeches


Crit Care. 2020;24(383) 

In This Article

MDROs: The Link With Colonization

MDR Pseudomonas aeruginosa, extended spectrum beta-lactamase-producing enterobacteria (ESBL-E), meticillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii and carbapenemase-producing Enterobacteriaceae (CPE) are the MDROs most commonly involved in HAP. Knowledge of local epidemiology is essential because there are significant differences in the local prevalence of each MDRO.[59]

The ENVIN-HELICS report does quantify the resistance of the most important microorganisms to different antibiotics, which enables an overall vision of expected resistance rates in the case of nosocomial pneumonia in Spanish ICU.[3]

The ENVIN-HELICS data also reveal an increased resistance of Klebsiella to carbapenems. The grade of resistance to antibiotics in the remaining bacteria has remained stable in the last few years. Table 1 shows the most important microorganisms that cause VAP and the percentage resistance to some of the main antibiotics used for these infections.

When evaluating the risk of development of nosocomial pneumonia in the ICU by a MDRO, we must first evaluate the risk factors for these pathogens. The European guidelines for nosocomial pneumonia[2] include risk factors for MDRO: septic shock, hospital ecology with high levels of MDROs, prior use of antibiotics, recent hospitalization (> 5 days) and prior colonization by MDROs. Risk factors are in general common to all MDRO; to discriminate different MDROs, we mainly base ourselves on local epidemiology and prior colonization of the patient.[60] The importance of colonization as a risk factor for suffering pneumonia by the colonizing microorganism varies according to the type of MDRO and location of the colonization. Table 2 describes the principal variables associated with resistance for the main MDROs causing NP.