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Semin Respir Crit Care Med 2022; 43(03): 426-439
DOI: 10.1055/s-0042-1749448
Review Article

Nosocomial Pneumonia in the Mechanically Ventilated Patient

Jonathon Fanning
1   Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
2   Faculty of Medicine, University of Queensland, Brisbane, Australia
3   Intensive Care Unit, Royal Brisbane and Women's Hospital, Queensland, Australia
4   Intensive Care Unit, St Andrew's War Memorial Hospital, Queensland, Australia
5   Nuffield Department of Population Health, Oxford University, United Kingdom
,
Mauro Panigada
6   Department of Anaesthesiology, Intensive Care and EmergencyFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Gianluigi Li Bassi
1   Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
2   Faculty of Medicine, University of Queensland, Brisbane, Australia
4   Intensive Care Unit, St Andrew's War Memorial Hospital, Queensland, Australia
7   Queensland University of Technology, Brisbane, Australia
8   Intensive Care Unit, The Wesley Hospital, Auchenflower, Queensland, Australia
9   Wesley Medical Research, The Wesley Hospital, Auchenflower, Australia
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Abstract

Ventilator-associated pneumonia (VAP) is a common complication occurring in critically ill patients who are mechanically ventilated and is the leading cause of nosocomial infection-related death. Etiologic agents for VAP widely differ based on the population of intensive care unit patients, duration of hospital stay, and prior antimicrobial therapy. VAP due to multidrug-resistant pathogens is associated with the highest morbidity and mortality, likely due to delays in appropriate antimicrobial treatment. International guidelines are currently available to guide diagnostic and therapeutic strategies. VAP can be prevented through various pharmacological and non-pharmacological interventions, which are more effective when grouped as bundles. When VAP is clinically suspected, diagnostic strategies should include early collection of respiratory samples to guide antimicrobial therapy. Empirical treatment should be based on the most likely etiologic microorganisms and antibiotics likely to be active against these microorganisms. Response to therapy should be reassessed after 3 to 5 days and antimicrobials adjusted or de-escalated to reduce the burden of the disease. Finally, considering that drug resistance is increasing worldwide, several novel antibiotics are being tested to efficiently treat VAP in the coming decades.

Keywords

ventilator-associated pneumonia - hospital-acquired pneumonia - ventilator-associated event - antibiotic - multidrug resistance - preventive bundle - diagnostic techniques


Publication History

Article published online:
17 June 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Kalil AC, Metersky ML, Klompas M. et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63 (05) e61-e111
    CrossrefPubMedGoogle Scholar
  • 2 Torres A, Niederman MS, Chastre J. et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50 (03) 1700582
    CrossrefPubMedGoogle Scholar
  • 3 Esperatti M, Ferrer M, Theessen A. et al. Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 2010; 182 (12) 1533-1539
    CrossrefPubMedGoogle Scholar
  • 4 Esperatti M, Ferrer M, Giunta V. et al. Validation of predictors of adverse outcomes in hospital-acquired pneumonia in the ICU. Crit Care Med 2013; 41 (09) 2151-2161
    CrossrefPubMedGoogle Scholar
  • 5 Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005; 50 (06) 725-739 , discussion 739–741
    PubMedGoogle Scholar
  • 6 Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G. Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 1987; 13 (05) 342-346
    CrossrefPubMedGoogle Scholar
  • 7 Martin-Loeches I, Torres A, Rinaudo M. et al. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms. J Infect 2015; 70 (03) 213-222
    CrossrefPubMedGoogle Scholar
  • 8 Martin-Loeches I, Deja M, Koulenti D. et al. EU-VAP Study Investigators. Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med 2013; 39 (04) 672-681
    CrossrefPubMedGoogle Scholar
  • 9 Dudeck MA, Weiner LM, Allen-Bridson K. et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control 2013; 41 (12) 1148-1166
    CrossrefPubMedGoogle Scholar
  • 10 Metersky ML, Wang Y, Klompas M, Eckenrode S, Bakullari A, Eldridge N. Trend in ventilator-associated pneumonia rates between 2005 and 2013. JAMA 2016; 316 (22) 2427-2429
    CrossrefPubMedGoogle Scholar
  • 11 Cook DJ, Walter SD, Cook RJ. et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129 (06) 433-440
    CrossrefPubMedGoogle Scholar
  • 12 Warren DK, Shukla SJ, Olsen MA. et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003; 31 (05) 1312-1317
    CrossrefPubMedGoogle Scholar
  • 13 Rello J, Ollendorf DA, Oster G. et al. VAP Outcomes Scientific Advisory Group. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122 (06) 2115-2121
    Google Scholar
  • 14 Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002; 122 (01) 262-268
    CrossrefPubMedGoogle Scholar
  • 15 Melsen WG, Rovers MM, Groenwold RHH. et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013; 13 (08) 665-671
    CrossrefPubMedGoogle Scholar
  • 16 Póvoa HCC, Chianca GC, Iorio NLPP. COVID-19: an alert to ventilator-associated bacterial pneumonia. Infect Dis Ther 2020; 9 (03) 417-420
    CrossrefPubMedGoogle Scholar
  • 17 Bassetti M, Kollef MH, Timsit JF. Bacterial and fungal superinfections in critically ill patients with COVID-19. Intensive Care Med 2020; 46 (11) 2071-2074
    CrossrefPubMedGoogle Scholar
  • 18 Petrilli CM, Jones SA, Yang J. et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020; 369: m1966
    Google Scholar
  • 19 Rouzé A, Martin-Loeches I, Povoa P. et al. coVAPid study Group. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med 2021; 47 (02) 188-198
    CrossrefPubMedGoogle Scholar
  • 20 Combes A, Figliolini C, Trouillet J-LL. et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002; 121 (05) 1618-1623
    CrossrefPubMedGoogle Scholar
  • 21 Teixeira PJZ, Seligman R, Hertz FT, Cruz DB, Fachel JMG. Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes. J Hosp Infect 2007; 65 (04) 361-367
    CrossrefPubMedGoogle Scholar
  • 22 Ferrer M, Ioanas M, Arancibia F, Marco MA, de la Bellacasa JP, Torres A. Microbial airway colonization is associated with noninvasive ventilation failure in exacerbation of chronic obstructive pulmonary disease. Crit Care Med 2005; 33 (09) 2003-2009
    CrossrefPubMedGoogle Scholar
  • 23 Fagon JY, Chastre J. Diagnosis and treatment of nosocomial pneumonia in ALI/ARDS patients. Eur Respir J Suppl 2003; 42: 77s-83s
    CrossrefPubMedGoogle Scholar
  • 24 Bronchard R, Albaladejo P, Brezac G. et al. Early onset pneumonia: risk factors and consequences in head trauma patients. Anesthesiology 2004; 100 (02) 234-239
    CrossrefPubMedGoogle Scholar
  • 25 Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med 1999; 160 (02) 608-613
    CrossrefPubMedGoogle Scholar
  • 26 Robert R, Grollier G, Frat J-PP. et al. Colonization of lower respiratory tract with anaerobic bacteria in mechanically ventilated patients. Intensive Care Med 2003; 29 (07) 1062-1068
    CrossrefPubMedGoogle Scholar
  • 27 Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest 1999; 115 (01) 178-183
    CrossrefPubMedGoogle Scholar
  • 28 Emonet S, Lazarevic V, Leemann Refondini C. et al. Identification of respiratory microbiota markers in ventilator-associated pneumonia. Intensive Care Med 2019; 45 (08) 1082-1092
    CrossrefPubMedGoogle Scholar
  • 29 Meersseman W, Lagrou K, Maertens J. et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med 2008; 177 (01) 27-34
    CrossrefPubMedGoogle Scholar
  • 30 Delisle M-SS, Williamson DR, Perreault MM, Albert M, Jiang X, Heyland DK. The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients. J Crit Care 2008; 23 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 31 Ricard J-D, Roux D. Candida pneumonia in the ICU: myth or reality?. Intensive Care Med 2009; 35 (09) 1500-1502
    CrossrefPubMedGoogle Scholar
  • 32 Van Biesen S, Kwa D, Bosman RJ, Juffermans NP. Detection of invasive pulmonary aspergillosis in COVID-19 with nondirected BAL. Am J Respir Crit Care Med 2020; 202 (08) 1171-1173
    CrossrefPubMedGoogle Scholar
  • 33 Loughlin L, Hellyer TP, White PL. et al. Pulmonary aspergillosis in patients with suspected ventilator-associated pneumonia in UK ICUs. Am J Respir Crit Care Med 2020; 202 (08) 1125-1132
    CrossrefPubMedGoogle Scholar
  • 34 Tejerina EE, Abril E, Padilla R. et al. Invasive aspergillosis in critically ill patients: an autopsy study. Mycoses 2019; 62 (08) 673-679
    CrossrefPubMedGoogle Scholar
  • 35 Tuxen DV, Cade JF, McDonald MI, Buchanan MR, Clark RJ, Pain MC. Herpes simplex virus from the lower respiratory tract in adult respiratory distress syndrome. Am Rev Respir Dis 1982; 126 (03) 416-419
    PubMedGoogle Scholar
  • 36 Camazine B, Antkowiak JG, Nava ME, Lipman BJ, Takita H. Herpes simplex viral pneumonia in the postthoracotomy patient. Chest 1995; 108 (03) 876-879
    CrossrefPubMedGoogle Scholar
  • 37 Byers RJ, Hasleton PS, Quigley A. et al. Pulmonary herpes simplex in burns patients. Eur Respir J 1996; 9 (11) 2313-2317
    CrossrefPubMedGoogle Scholar
  • 38 Luyt C-EE, Combes A, Deback C. et al. Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 2007; 175 (09) 935-942
    CrossrefPubMedGoogle Scholar
  • 39 Heininger A, Haeberle H, Fischer I. et al. Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis. Crit Care 2011; 15 (02) R77
    CrossrefPubMedGoogle Scholar
  • 40 Chiche L, Forel J-MM, Roch A. et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med 2009; 37 (06) 1850-1857
    CrossrefPubMedGoogle Scholar
  • 41 Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 2020; 81 (02) 266-275
    CrossrefPubMedGoogle Scholar
  • 42 Li Bassi G, Luque N, Martí JD. et al. Endotracheal tubes for critically ill patients: an in vivo analysis of associated tracheal injury, mucociliary clearance, and sealing efficacy. Chest 2015; 147 (05) 1327-1335
    CrossrefPubMedGoogle Scholar
  • 43 Høiby N, Bjarnsholt T, Moser C. et al. ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014. Clin Microbiol Infect 2015; 21 (Suppl. 01) S1-S25
    CrossrefPubMedGoogle Scholar
  • 44 Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284 (5418): 1318-1322
    CrossrefPubMedGoogle Scholar
  • 45 Wilson A, Gray D, Karakiozis J, Thomas J. Advanced endotracheal tube biofilm stage, not duration of intubation, is related to pneumonia. J Trauma Acute Care Surg 2012; 72 (04) 916-923
    CrossrefPubMedGoogle Scholar
  • 46 Gil-Perotin S, Ramirez P, Marti V. et al. Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care 2012; 16 (03) R93
    CrossrefPubMedGoogle Scholar
  • 47 Weber DJ, Rutala WA. Lessons learned from outbreaks and pseudo-outbreaks associated with bronchoscopy. Infect Control Hosp Epidemiol 2012; 33 (03) 230-234
    CrossrefPubMedGoogle Scholar
  • 48 Guyot A, Turton JF, Garner D. Outbreak of Stenotrophomonas maltophilia on an intensive care unit. J Hosp Infect 2013; 85 (04) 303-307
    CrossrefPubMedGoogle Scholar
  • 49 Kikuchi T, Nagashima G, Taguchi K. et al. Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant Pseudomonas in an intensive care unit. J Hosp Infect 2007; 65 (01) 54-57
    CrossrefPubMedGoogle Scholar
  • 50 Bou R, Ramos P. Outbreak of nosocomial Legionnaires' disease caused by a contaminated oxygen humidifier. J Hosp Infect 2009; 71 (04) 381-383
    CrossrefPubMedGoogle Scholar
  • 51 Rogues AM, Maugein J, Allery A. et al. Electronic ventilator temperature sensors as a potential source of respiratory tract colonization with Stenotrophomonas maltophilia . J Hosp Infect 2001; 49 (04) 289-292
    CrossrefPubMedGoogle Scholar
  • 52 Pegues CF, Pegues DA, Ford DS. et al. Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak. Epidemiol Infect 1996; 116 (03) 309-317
    CrossrefPubMedGoogle Scholar
  • 53 Enoch DA, Summers C, Brown NM. et al. Investigation and management of an outbreak of multidrug-carbapenem-resistant Acinetobacter baumannii in Cambridge, UK. J Hosp Infect 2008; 70 (02) 109-118
    CrossrefPubMedGoogle Scholar
  • 54 Johanson Jr WG, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972; 77 (05) 701-706
    CrossrefPubMedGoogle Scholar
  • 55 Feldman C, Kassel M, Cantrell J. et al. The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. Eur Respir J 1999; 13 (03) 546-551
    CrossrefPubMedGoogle Scholar
  • 56 Michelson A, Kamp HD, Schuster B. Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation. Anaesthesist 1991; 40 (02) 100-104
    PubMedGoogle Scholar
  • 57 Rouby JJ, Laurent P, Gosnach M. et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994; 150 (03) 776-783
    CrossrefPubMedGoogle Scholar
  • 58 Holzapfel L, Chastang C, Demingeon G, Bohe J, Piralla B, Coupry A. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med 1999; 159 (03) 695-701
    CrossrefPubMedGoogle Scholar
  • 59 Torres A, El-Ebiary M, Soler N, Montón C, Fàbregas N, Hernández C. Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia. Eur Respir J 1996; 9 (08) 1729-1735
    CrossrefPubMedGoogle Scholar
  • 60 Donowitz LG, Page MC, Mileur BL, Guenthner SH. Alteration of normal gastric flora in critical care patients receiving antacid and cimetidine therapy. Infect Control 1986; 7 (01) 23-26
    CrossrefPubMedGoogle Scholar
  • 61 Bonten MJ, Gaillard CA, van der Geest S. et al. The role of intragastric acidity and stress ulcus prophylaxis on colonization and infection in mechanically ventilated ICU patients. A stratified, randomized, double-blind study of sucralfate versus antacids. Am J Respir Crit Care Med 1995; 152 (6 Pt 1): 1825-1834
    CrossrefPubMedGoogle Scholar
  • 62 Krag M, Marker S, Perner A. et al. SUP-ICU trial group. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med 2018; 379 (23) 2199-2208
    CrossrefPubMedGoogle Scholar
  • 63 Reignier J, Mercier E, Le Gouge A. et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013; 309 (03) 249-256
    CrossrefPubMedGoogle Scholar
  • 64 Roquilly A, Torres A, Villadangos JA. et al. Pathophysiological role of respiratory dysbiosis in hospital-acquired pneumonia. Lancet Respir Med 2019; 7 (08) 710-720
    CrossrefPubMedGoogle Scholar
  • 65 Segal LN, Clemente JC, Tsay JCJ. et al. Enrichment of the lung microbiome with oral taxa is associated with lung inflammation of a Th17 phenotype. Nat Microbiol 2016; 1 (05) 16031
    CrossrefPubMedGoogle Scholar
  • 66 Klompas M, Li L, Kleinman K, Szumita PM, Massaro AF. Associations between ventilator bundle components and outcomes. JAMA Intern Med 2016; 176 (09) 1277-1283
    CrossrefPubMedGoogle Scholar
  • 67 Berenholtz SM, Pham JC, Thompson DA. et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011; 32 (04) 305-314
    CrossrefPubMedGoogle Scholar
  • 68 Bouadma L, Deslandes E, Lolom I. et al. Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Clin Infect Dis 2010; 51 (10) 1115-1122
    CrossrefPubMedGoogle Scholar
  • 69 Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M. et al. Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU “pneumonia zero” program. Crit Care Med 2018; 46 (02) 181-188
    CrossrefPubMedGoogle Scholar
  • 70 Sinuff T, Muscedere J, Cook DJ. et al. Canadian Critical Care Trials Group. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med 2013; 41 (01) 15-23
    CrossrefPubMedGoogle Scholar
  • 71 Organization WH. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge: Clean Care Is Safer Care. Geneva, Switzerland: World Health Organization, Patient Safety; ; 2009
    Google Scholar
  • 72 Schwebel C, Clec'h C, Magne S. et al. OUTCOMEREA Study Group. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study*. Crit Care Med 2013; 41 (08) 1919-1928
    CrossrefPubMedGoogle Scholar
  • 73 Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375 (9713): 475-480
    CrossrefPubMedGoogle Scholar
  • 74 Schweickert WD, Pohlman MC, Pohlman AS. et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373 (9678): 1874-1882
    CrossrefPubMedGoogle Scholar
  • 75 Li Bassi G, Ranzani OT, Marti JD. et al. An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures. Crit Care Med 2013; 41 (02) 518-526
    CrossrefPubMedGoogle Scholar
  • 76 Philippart F, Gaudry S, Quinquis L. et al. TOP-Cuff Study Group. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. Am J Respir Crit Care Med 2015; 191 (06) 637-645
    CrossrefPubMedGoogle Scholar
  • 77 Monsel A, Lu Q, Le Corre M. et al. TETRIS Study Group. Tapered-cuff endotracheal tube does not prevent early postoperative pneumonia compared with spherical-cuff endotracheal tube after major vascular surgery: a randomized controlled trial. Anesthesiology 2016; 124 (05) 1041-1052
    CrossrefPubMedGoogle Scholar
  • 78 Nseir S, Lorente L, Ferrer M. et al. Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data. Ann Intensive Care 2015; 5 (01) 43
    CrossrefPubMedGoogle Scholar
  • 79 Nseir S, Zerimech F, Fournier C. et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med 2011; 184 (09) 1041-1047
    CrossrefPubMedGoogle Scholar
  • 80 Kollef MH, Afessa B, Anzueto A. et al. NASCENT Investigation Group. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008; 300 (07) 805-813
    CrossrefPubMedGoogle Scholar
  • 81 Caroff DA, Li L, Muscedere J, Klompas M. Subglottic secretion drainage and objective outcomes: a systematic review and meta-analysis. Crit Care Med 2016; 44 (04) 830-840
    CrossrefPubMedGoogle Scholar
  • 82 Suys E, Nieboer K, Stiers W, De Regt J, Huyghens L, Spapen H. Intermittent subglottic secretion drainage may cause tracheal damage in patients with few oropharyngeal secretions. Intensive Crit Care Nurs 2013; 29 (06) 317-320
    CrossrefPubMedGoogle Scholar
  • 83 Han J, Liu Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respir Care 2010; 55 (04) 467-474
    PubMedGoogle Scholar
  • 84 Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999; 354 (9193): 1851-1858
    CrossrefPubMedGoogle Scholar
  • 85 van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH. et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 2006; 34 (02) 396-402
    CrossrefPubMedGoogle Scholar
  • 86 Li Bassi G, Marti JD, Saucedo L. et al. Gravity predominates over ventilatory pattern in the prevention of ventilator-associated pneumonia. Crit Care Med 2014; 42 (09) e620-e627
    CrossrefPubMedGoogle Scholar
  • 87 Li Bassi G, Panigada M, Ranzani OT. et al. Gravity-VAP Network. Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia. Intensive Care Med 2017; 43 (11) 1572-1584
    CrossrefPubMedGoogle Scholar
  • 88 Klompas M, Branson R, Eichenwald EC. et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 (Suppl. 02) S133-S154
    CrossrefPubMedGoogle Scholar
  • 89 Prod'hom G, Leuenberger P, Koerfer J. et al. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial. Ann Intern Med 1994; 120 (08) 653-662
    CrossrefPubMedGoogle Scholar
  • 90 Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013; 41 (02) 646-655
    CrossrefPubMedGoogle Scholar
  • 91 de Smet AMGA, Kluytmans JAJW, Cooper BS. et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360 (01) 20-31
    CrossrefPubMedGoogle Scholar
  • 92 Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11 (11) 845-854
    CrossrefPubMedGoogle Scholar
  • 93 Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 2014; 174 (05) 751-761
    CrossrefPubMedGoogle Scholar
  • 94 Dale CM, Rose L, Carbone S. et al. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial. Intensive Care Med 2021; 47 (11) 1295-1302
    CrossrefPubMedGoogle Scholar
  • 95 Oostdijk EAN, Kesecioglu J, Schultz MJ. et al. Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial. JAMA 2014; 312 (14) 1429-1437
    CrossrefPubMedGoogle Scholar
  • 96 de Smet AMGA, Kluytmans JAJW, Blok HEM. et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis 2011; 11 (05) 372-380
    CrossrefPubMedGoogle Scholar
  • 97 Price R, MacLennan G, Glen J. SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014; 348 (mar31 2): g2197-g2197
    CrossrefPubMedGoogle Scholar
  • 98 Wittekamp BH, Plantinga NL, Cooper BS. et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial. JAMA 2018; 320 (20) 2087-2098
    CrossrefPubMedGoogle Scholar
  • 99 Sirvent JM, Torres A, El-Ebiary M, Castro P, de Batlle J, Bonet A. Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 1997; 155 (05) 1729-1734
    CrossrefPubMedGoogle Scholar
  • 100 François B, Cariou A, Clere-Jehl R. et al. CRICS-TRIGGERSEP Network and the ANTHARTIC Study Group. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med 2019; 381 (19) 1831-1842
    CrossrefPubMedGoogle Scholar
  • 101 Tejerina E, Esteban A, Fernández-Segoviano P. et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care 2010; 25 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 102 Fàbregas N, Ewig S, Torres A. et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 1999; 54 (10) 867-873
    CrossrefPubMedGoogle Scholar
  • 103 Patel IS, Vlahos I, Wilkinson TMA. et al. Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004; 170 (04) 400-407
    CrossrefPubMedGoogle Scholar
  • 104 Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991; 143 (5 Pt 1): 1121-1129
    CrossrefPubMedGoogle Scholar
  • 105 Ekren PK, Ranzani OT, Ceccato A. et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society guideline criteria for risk of multidrug-resistant pathogens in patients with hospital-acquired and ventilator-associated pneumonia in the ICU. Am J Respir Crit Care Med 2018; 197 (06) 826-830
    CrossrefPubMedGoogle Scholar
  • 106 Póvoa P, Martin-Loeches I, Ramirez P. et al. Biomarker kinetics in the prediction of VAP diagnosis: results from the BioVAP study. Ann Intensive Care 2016; 6 (01) 32
    CrossrefPubMedGoogle Scholar
  • 107 Hellyer TP, McAuley DF, Walsh TS. et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation. Lancet Respir Med 2020; 8 (02) 182-191
    CrossrefPubMedGoogle Scholar
  • 108 Paonessa JR, Shah RD, Pickens CI. et al. Rapid detection of methicillin-resistant Staphylococcus aureus in BAL: a pilot randomized controlled trial. Chest 2019; 155 (05) 999-1007
    CrossrefPubMedGoogle Scholar
  • 109 Ranzani OT, Motos A, Chiurazzi C. et al. Diagnostic accuracy of Gram staining when predicting staphylococcal hospital-acquired pneumonia and ventilator-associated pneumonia: a systematic review and meta-analysis. Clin Microbiol Infect 2020; 26 (11) 1456-1463
    CrossrefPubMedGoogle Scholar
  • 110 Jourdain B, Novara A, Joly-Guillou ML. et al. Role of quantitative cultures of endotracheal aspirates in the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 152 (01) 241-246
    CrossrefPubMedGoogle Scholar
  • 111 Torres A, Fàbregas N, Ewig S, de la Bellacasa JP, Bauer TT, Ramirez J. Sampling methods for ventilator-associated pneumonia: validation using different histologic and microbiological references. Crit Care Med 2000; 28 (08) 2799-2804
    CrossrefPubMedGoogle Scholar
  • 112 Guillamet MCV, Burnham JP, Kollef MH. Novel approaches to hasten detection of pathogens and antimicrobial resistance in the intensive care unit. Semin Respir Crit Care Med 2019; 40 (04) 454-464
    Article in Thieme ConnectPubMedGoogle Scholar
  • 113 Trevino SE, Pence MA, Marschall J, Kollef MH, Babcock HM, Burnham CD. Rapid MRSA PCR on respiratory specimens from ventilated patients with suspected pneumonia: a tool to facilitate antimicrobial stewardship. Eur J Clin Microbiol Infect Dis 2017; 36 (05) 879-885
    CrossrefPubMedGoogle Scholar
  • 114 Lee SH, Ruan SY, Pan SC, Lee TF, Chien JY, Hsueh PR. Performance of a multiplex PCR pneumonia panel for the identification of respiratory pathogens and the main determinants of resistance from the lower respiratory tract specimens of adult patients in intensive care units. J Microbiol Immunol Infect 2019; 52 (06) 920-928
    CrossrefPubMedGoogle Scholar
  • 115 Gadsby NJ, McHugh MP, Forbes C. et al. Comparison of Unyvero P55 Pneumonia Cartridge, in-house PCR and culture for the identification of respiratory pathogens and antibiotic resistance in bronchoalveolar lavage fluids in the critical care setting. Eur J Clin Microbiol Infect Dis 2019; 38 (06) 1171-1178
    CrossrefPubMedGoogle Scholar
  • 116 Tenover FC. Developing molecular amplification methods for rapid diagnosis of respiratory tract infections caused by bacterial pathogens. Clin Infect Dis 2011; 52 (Suppl. 04) S338-S345
    CrossrefPubMedGoogle Scholar
  • 117 Bouza E, Torres MV, Radice C. et al. Direct E-test (AB Biodisk) of respiratory samples improves antimicrobial use in ventilator-associated pneumonia. Clin Infect Dis 2007; 44 (03) 382-387
    CrossrefPubMedGoogle Scholar
  • 118 Berton DC, Kalil AC, Teixeira PJZ. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst Rev 2012; 1: CD006482
    PubMedGoogle Scholar
  • 119 Dupont H, Mentec H, Sollet JP, Bleichner G. Impact of appropriateness of initial antibiotic therapy on the outcome of ventilator-associated pneumonia. Intensive Care Med 2001; 27 (02) 355-362
    CrossrefPubMedGoogle Scholar
  • 120 Sanchez-Nieto JM, Torres A, Garcia-Cordoba F. et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med 1998; 157 (02) 371-376
    CrossrefPubMedGoogle Scholar
  • 121 Rello J, Ausina V, Ricart M, Castella J, Prats G. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 1993; 104 (Suppl. 04) 1230-1235
    CrossrefPubMedGoogle Scholar
  • 122 Group CCCT. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006; 355 (25) 2619-2630
    CrossrefPubMedGoogle Scholar
  • 123 Magill SS, Klompas M, Balk R. et al. Developing a new, national approach to surveillance for ventilator-associated events*. Crit Care Med 2013; 41 (11) 2467-2475
    CrossrefPubMedGoogle Scholar
  • 124 Boyer AF, Schoenberg N, Babcock H, McMullen KM, Micek ST, Kollef MH. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015; 147 (01) 68-81
    CrossrefPubMedGoogle Scholar
  • 125 Hanberger H, Garcia-Rodriguez JA, Gobernado M, Goossens H, Nilsson LE, Struelens MJ. French and Portuguese ICU Study Groups. Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. JAMA 1999; 281 (01) 67-71
    CrossrefPubMedGoogle Scholar
  • 126 Fagon JY, Chastre J, Domart Y. et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989; 139 (04) 877-884
    CrossrefPubMedGoogle Scholar
  • 127 Torres A, Aznar R, Gatell JM. et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142 (03) 523-528
    CrossrefPubMedGoogle Scholar
  • 128 Rello J, Gallego M, Mariscal D, Soñora R, Valles J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med 1997; 156 (01) 196-200
    CrossrefPubMedGoogle Scholar
  • 129 Kumar A, Safdar N, Kethireddy S, Chateau D. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med 2010; 38 (08) 1651-1664
    CrossrefPubMedGoogle Scholar
  • 130 Najmeddin F, Shahrami B, Azadbakht S. et al. Evaluation of epithelial lining fluid concentration of amikacin in critically ill patients with ventilator-associated pneumonia. J Intensive Care Med 2020; 35 (04) 400-404
    CrossrefPubMedGoogle Scholar
  • 131 Paul M, Daikos GL, Durante-Mangoni E. et al. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18 (04) 391-400
    CrossrefPubMedGoogle Scholar
  • 132 Aarts M-AWA, Hancock JN, Heyland D, McLeod RS, Marshall JC. Empiric antibiotic therapy for suspected ventilator-associated pneumonia: a systematic review and meta-analysis of randomized trials. Crit Care Med 2008; 36 (01) 108-117
    CrossrefPubMedGoogle Scholar
  • 133 Palmer LB. Aerosolized antibiotics in critically ill ventilated patients. Curr Opin Crit Care 2009; 15 (05) 413-418
    CrossrefPubMedGoogle Scholar
  • 134 Palmer LB, Smaldone GC. Reduction of bacterial resistance with inhaled antibiotics in the intensive care unit. Am J Respir Crit Care Med 2014; 189 (10) 1225-1233
    CrossrefPubMedGoogle Scholar
  • 135 Stokker J, Karami M, Hoek R, Gommers D, van der Eerden M. Effect of adjunctive tobramycin inhalation versus placebo on early clinical response in the treatment of ventilator-associated pneumonia: the VAPORISE randomized-controlled trial. Intensive Care Med 2020; 46 (03) 546-548
    CrossrefPubMedGoogle Scholar
  • 136 Niederman MS, Alder J, Bassetti M. et al. Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial. Lancet Infect Dis 2020; 20 (03) 330-340
    CrossrefPubMedGoogle Scholar
  • 137 Kollef MH, Ricard J-DD, Roux D. et al. A randomized trial of the amikacin fosfomycin inhalation system for the adjunctive therapy of gram-negative ventilator-associated pneumonia: IASIS Trial. Chest 2017; 151 (06) 1239-1246
    CrossrefPubMedGoogle Scholar
  • 138 Wunderink RG, Roquilly A, Croce M. et al. A phase 3, randomized, double-blind study comparing tedizolid phosphate and linezolid for treatment of ventilated gram-positive hospital-acquired or ventilator-associated bacterial pneumonia. Clin Infect Dis 2021; 73 (03) e710-e718
    CrossrefPubMedGoogle Scholar
  • 139 Bassetti M, Vena A, Castaldo N, Righi E, Peghin M. New antibiotics for ventilator-associated pneumonia. Curr Opin Infect Dis 2018; 31 (02) 177-186
    CrossrefPubMedGoogle Scholar
  • 140 Kollef MH, Nováček M, Kivistik Ü. et al. Ceftolozane-tazobactam versus meropenem for treatment of nosocomial pneumonia (ASPECT-NP): a randomised, controlled, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis 2019; 19 (12) 1299-1311
    CrossrefPubMedGoogle Scholar
  • 141 Torres A, Zhong N, Pachl J. et al. Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial. Lancet Infect Dis 2018; 18 (03) 285-295
    CrossrefPubMedGoogle Scholar
  • 142 Zaragoza, R., Vidal-Cortés, P., Aguilar, G. et al. Update of the treatment of nosocomial pneumonia in the ICU. Crit Care 24, 383 (2020). https://doi.org/10.1186/s13054-020-03091-2.
    PubMed
  • 143 Wunderink RG, Giamarellos-Bourboulis EJ, Rahav G. et al. Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant enterobacteriaceae infections: the TANGO II randomized clinical trial. Infect Dis Ther 2018; 7 (04) 439-455
    CrossrefPubMedGoogle Scholar
  • 144 Motsch J, Murta de Oliveira C, Stus V. et al. RESTORE-IMI 1: a multicenter, randomized, double-blind trial comparing efficacy and safety of imipenem/relebactam vs colistin plus imipenem in patients with imipenem-nonsusceptible bacterial infections. Clin Infect Dis 2020; 70 (09) 1799-1808
    CrossrefPubMedGoogle Scholar
  • 145 Wunderink RG, Matsunaga Y, Ariyasu M. et al. Cefiderocol versus high-dose, extended-infusion meropenem for the treatment of gram-negative nosocomial pneumonia (APEKS-NP): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis 2021; 21 (02) 213-225
    CrossrefPubMedGoogle Scholar
  • 146 Ceccato A, Dominedò C, Ferrer M. et al. Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study. Eur Respir J 2021; 2100620: 2100620
    PubMedGoogle Scholar
  • 147 Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK. Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 2013; 144 (06) 1759-1767
    CrossrefPubMedGoogle Scholar
  • 148 Chastre J, Wolff M, Fagon J-YY. et al. PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003; 290 (19) 2588-2598
    CrossrefPubMedGoogle Scholar
  • 149 Zagli G, Cozzolino M, Terreni A, Biagioli T, Caldini AL, Peris A. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography. Chest 2014; 146 (06) 1578-1585
    CrossrefPubMedGoogle Scholar
  • 150 Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for “lung monitoring” of ventilated patients. Anesthesiology 2015; 122 (02) 437-447
    CrossrefPubMedGoogle Scholar