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Semin Respir Crit Care Med 2017; 38(03): 264-270
DOI: 10.1055/s-0037-1602582
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Should We Treat Ventilator-Associated Tracheobronchitis with Antibiotics?

Ignacio Martin-Loeches
1   Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
2   Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland
,
John Davies Coakley
1   Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
,
Saad Nseir
3   Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
› Author Affiliations
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Publication History

Publication Date:
04 June 2017 (online)

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Abstract

Patients admitted to intensive care units (ICUs) often require lung organ support. The use of mechanical ventilation, while lifesaving can be associated with subsequent complications. The most common complication in patients under mechanical ventilation is the development of ventilator-associated lower respiratory tract infections (VA-LRTIs). Before the development of VA-LRTI, there is a continuum process that ranges from airway colonization to ventilator-associated pneumonia (VAP). There is an intermediate process called ventilator-associated tracheobronchitis (VAT). Contemporary treatment of VA-LRTI emphasizes the importance of prompt broad-spectrum antimicrobial therapy. Previous studies reported prolonged duration of mechanical ventilation and ICU stay in patients with VAT. This negative impact on outcome is related to increased inflammation of the lower respiratory tract, sputum production, and higher rates of VAP. Extubation failure and difficult weaning have been reported to be associated with increased sputum volume in mechanically ventilated patients. Antibiotic treatment for VAT patients is still a matter for debate. Observational studies suggested a beneficial effect of antimicrobial treatment in VAT patients, including a reduced duration of mechanical ventilation and lower rates of subsequent VAP. Previous studies demonstrated beneficial effects of systemic and aerosolized antibiotics in preventing VAP in critically ill patients. However, antibiotic treatment is a recognized risk factor for the emergence of multidrug-resistant bacteria. Infections related to these bacteria are associated with increased morbidity, mortality, and cost. Therefore, a large well-designed study is warranted to determine whether patients with VAT should receive antimicrobials. Furthermore, a short course of antimicrobials could be sufficient in these patients.

Keywords

sepsis - intensive care - ventilator-associated tracheobronchitis - pneumonia - antimicrobial
 

  • References

  • 1 Nseir S, Di Pompeo C, Soubrier S. , et al. Impact of ventilator-associated pneumonia on outcome in patients with COPD. Chest 2005; 128 (03) 1650-1656
    CrossrefPubMedGoogle Scholar
  • 2 Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. ; The Canadian Critical Trials Group. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999; 159 (4 Pt 1): 1249-1256
    CrossrefPubMedGoogle Scholar
  • 3 Nseir S, Di Pompeo C, Pronnier P. , et al. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur Respir J 2002; 20 (06) 1483-1489
    CrossrefPubMedGoogle Scholar
  • 4 Karvouniaris M, Makris D, Manoulakas E. , et al. Ventilator-associated tracheobronchitis increases the length of intensive care unit stay. Infect Control Hosp Epidemiol 2013; 34 (08) 800-808
    CrossrefPubMedGoogle Scholar
  • 5 Mehta AB, Syeda SN, Wiener RS, Walkey AJ. Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care 2015; 30 (06) 1217-1221
    CrossrefPubMedGoogle Scholar
  • 6 Martin-Loeches I, Povoa P, Rodríguez A. , et al; TAVeM study. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015; 3 (11) 859-868
    CrossrefPubMedGoogle Scholar
  • 7 Craven DE, Hudcova J, Rashid J. Antibiotic therapy for ventilator-associated tracheobronchitis: a standard of care to reduce pneumonia, morbidity and costs?. Curr Opin Pulm Med 2015; 21 (03) 250-259
    PubMedGoogle Scholar
  • 8 Nseir S, Deplanque X, Di Pompeo C, Diarra M, Roussel-Delvallez M, Durocher A. Risk factors for relapse of ventilator-associated pneumonia related to nonfermenting gram negative bacilli: a case-control study. J Infect 2008; 56 (05) 319-325
    CrossrefPubMedGoogle Scholar
  • 9 Nseir S, Martin-Loeches I, Makris D. , et al. Impact of appropriate antimicrobial treatment on transition from ventilator-associated tracheobronchitis to ventilator-associated pneumonia. Crit Care 2014; 18 (03) R129
    CrossrefPubMedGoogle Scholar
  • 10 Martin-Loeches I, Papiol E, Almansa R, López-Campos G, Bermejo-Martin JF, Rello J. Intubated patients developing tracheobronchitis or pneumonia have distinctive complement system gene expression signatures in the pre-infection period: a pilot study. Med Intensiva 2012; 36 (04) 257-263
    CrossrefPubMedGoogle Scholar
  • 11 Muscedere JG, Shorr AF, Jiang X, Day A, Heyland DK. ; Canadian Critical Care Trials Group. The adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: an important determinant of outcome. J Crit Care 2012; 27 (03) 322.e7-322.e14
    CrossrefPubMedGoogle Scholar
  • 12 Mariya Joseph N, Sistla S, Kumar Dutta T, Shankar Badhe A, Rasitha D, Chandra Parija S. Outcome of ventilator-associated pneumonia: impact of antibiotic therapy and other factors. Australas Med J 2012; 5 (02) 135-140
    PubMedGoogle Scholar
  • 13 Martin-Loeches I, Bos LD, Povoa P. , et al. Tumor necrosis factor receptor 1 (TNFRI) for ventilator-associated pneumonia diagnosis by cytokine multiplex analysis. Intensive Care Med Exp 2015; 3 (01) 26
    CrossrefPubMedGoogle Scholar
  • 14 Craven DE, Lei Y, Ruthazer R, Sarwar A, Hudcova J. Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia. Am J Med 2013; 126 (06) 542-549
    CrossrefPubMedGoogle Scholar
  • 15 Mongodi S, Via G, Girard M. , et al. Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest 2016; 149 (04) 969-980
    CrossrefPubMedGoogle Scholar
  • 16 Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med 2004; 30 (07) 1334-1339
    PubMedGoogle Scholar
  • 17 Mokhlesi B, Tulaimat A, Gluckman TJ, Wang Y, Evans AT, Corbridge TC. Predicting extubation failure after successful completion of a spontaneous breathing trial. Respir Care 2007; 52 (12) 1710-1717
    PubMedGoogle Scholar
  • 18 Nseir S, Di Pompeo C, Soubrier S. , et al. Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: a case-control study. Infection 2004; 32 (04) 210-216
    CrossrefPubMedGoogle Scholar
  • 19 Nseir S, Di Pompeo C, Soubrier S. , et al. Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure: a case-control study. Crit Care 2005; 9 (03) R238-R245
    CrossrefPubMedGoogle Scholar
  • 20 Dallas J, Skrupky L, Abebe N, Boyle III WA, Kollef MH. Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population. Chest 2011; 139 (03) 513-518
    CrossrefPubMedGoogle Scholar
  • 21 Torres A, Valencia M. Does ventilator-associated tracheobronchitis need antibiotic treatment?. Crit Care 2005; 9 (03) 255-256
    CrossrefPubMedGoogle Scholar
  • 22 Torres A, Ewig S, Lode H, Carlet J. ; European HAP working group. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009; 35 (01) 9-29
    CrossrefPubMedGoogle Scholar
  • 23 Rodríguez A, Póvoa P, Nseir S, Salluh J, Curcio D, Martín-Loeches I. ; TAVeM group investigators. Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey. Crit Care 2014; 18 (01) R32
    CrossrefPubMedGoogle Scholar
  • 24 Palmer LB, Smaldone GC, Chen JJ. , et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008; 36 (07) 2008-2013
    CrossrefPubMedGoogle Scholar
  • 25 Nseir S, Favory R, Jozefowicz E. , et al; VAT Study Group. Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study. Crit Care 2008; 12 (03) R62
    CrossrefPubMedGoogle Scholar
  • 26 Agrafiotis M, Siempos II, Falagas ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med 2010; 104 (03) 325-336
    CrossrefPubMedGoogle Scholar
  • 27 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
  • 28 Acquarolo A, Urli T, Perone G, Giannotti C, Candiani A, Latronico N. Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study. Intensive Care Med 2005; 31 (04) 510-516
    CrossrefPubMedGoogle Scholar
  • 29 Bouza E, Granda MJ, Hortal J, Barrio JM, Cercenado E, Muñoz P. Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients. Intensive Care Med 2013; 39 (09) 1547-1555
    CrossrefPubMedGoogle Scholar
  • 30 Niederman MS. Use of broad-spectrum antimicrobials for the treatment of pneumonia in seriously ill patients: maximizing clinical outcomes and minimizing selection of resistant organisms. Clin Infect Dis 2006; 42 (Suppl. 02) S72-S81
    CrossrefPubMedGoogle Scholar
  • 31 Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165 (07) 867-903
    CrossrefPubMedGoogle Scholar
  • 32 Tabah A, Koulenti D, Laupland K. , et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012; 38 (12) 1930-1945
    CrossrefPubMedGoogle Scholar