Update on ventilator-associated pneumonia

Abstract

Ventilator-associated pneumonia (VAP) is the most frequent life-threatening nosocomial infection in intensive care units. The diagnostic is difficult because radiological and clinical signs are inaccurate and could be associated with various respiratory diseases. The concept of infection-related ventilator-associated complication has been proposed as a surrogate of VAP to be used as a benchmark indicator of quality of care. Indeed, bundles of prevention measures are effective in decreasing the VAP rate. In case of VAP suspicion, respiratory secretions must be collected for bacteriological secretions before any new antimicrobials. Quantitative distal bacteriological exams may be preferable for a more reliable diagnosis and therefore a more appropriate use antimicrobials. To improve the prognosis, the treatment should be adequate as soon as possible but should avoid unnecessary broad-spectrum antimicrobials to limit antibiotic selection pressure. For empiric treatments, the selection of antimicrobials should consider the local prevalence of microorganisms along with their associated susceptibility profiles. Critically ill patients require high dosages of antimicrobials and more specifically continuous or prolonged infusions for beta-lactams. After patient stabilization, antimicrobials should be maintained for 7–8 days. The evaluation of VAP treatment based on 28-day mortality is being challenged by regulatory agencies, which are working on alternative surrogate endpoints and on trial design optimization.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol in off-pump coronary artery bypass graft surgery. A prospective cohort feasibility study

“…Patients in the ERAS group spent less time in the ICU (20 [16][17][18][19][20][21][22][23][24] h) compared to the standard care group (48 [36-48] h; P = 0.00001). Moreover, the ERAS patients were discharged from the hospital before the standard care patients.…”

“…The postoperative drainage time was significantly shorter in the ERAS group. Thoracic drains were removed after 12 (11)(12)(13)(14)(15)(16)(17) h in the ERAS group and 23 (19)(20)(21)(22)(23)(24)(25)(26)(27) h (P = 0.00001) in the standard care (Figure 1).…”

Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumonia or ventilated hospital-acquired pneumonia

“…The antimicrobial selection in our centre follows the ATS/IDSA guidelines 15 adapted to the local epidemiology of antimicrobial resistance. 16 The group successively reviewed all the data without and then with the results of the M-PCR. The data reviewed were the entire medical le of the patients including clinical, radiological and Gram staining results related to the episode of pneumonia and medical history with comorbidities as well as previous bacteriological results including carriage, colonization and infections with susceptibility pro les and previous antimicrobial therapies.…”

Relationship between the composition of the digestive microbiota and the concentrations of opportunistic pathogens in intensive care patients

“…During their stay in the ICU, approximately 20% patients develop a hospital-acquired infection 13 which represents the leading cause of death 14 . Most of these infections are ventilator associated pneumonia (VAP), one third of which are caused by MDR-GNB 15 . In total, MDR-GNB are responsible of more than 40% of hospital-acquired infections in ICU and double the relative risk of death 16 .…”