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Semin Respir Crit Care Med 2014; 35(04): 469-481
DOI: 10.1055/s-0034-1384752
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ventilator-Associated Pneumonia

Gianluigi Li Bassi
1   Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona, Spain
2   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Spain
,
Miquel Ferrer
1   Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona, Spain
2   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Spain
,
Joan Daniel Marti
1   Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona, Spain
,
Talitha Comaru
1   Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona, Spain
,
Antoni Torres
1   Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona, Spain
2   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Mallorca, Spain
› Author Affiliations
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Publication History

Publication Date:
11 August 2014 (online)

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Abstract

Ventilator-associated pneumonia (VAP) is an iatrogenic pulmonary infection that develops in tracheally intubated patients on mechanical ventilation for at least 48 hours. VAP is the nosocomial infection with the greatest impact on patient outcomes and health care costs. Endogenous colonization by aerobic gram-negative pathogens, that is, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus play a pivotal role in the pathogenesis of VAP. Several preventive strategies have shown efficacy in decreasing VAP incidence and are often implemented altogether as a prevention bundle. In patients with clinical suspicion of VAP, respiratory samples should be promptly collected. The empiric treatment should be based on the local prevalence of pathogens, duration of hospital stay, and prior antimicrobial therapy. The antibiotics can be stopped or adjusted to more narrow-spectrum once cultures and susceptibilities are available.

Keywords

ventilator-associated pneumonia - nosocomial pneumonia - pseudomonas aeruginosa - endotracheal tube - mechanical ventilation
 

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