Drugs

, Volume 70, Issue 15, pp 1927–1944

Diagnosis, Management and Prevention of Ventilator-Associated Pneumonia

An Update
  • Jean-Louis Vincent
  • Dalton de Souza Barros
  • Silvia Cianferoni
Therapy In Practice

DOI: 10.2165/11538080-000000000-00000

Cite this article as:
Vincent, J., de Souza Barros, D. & Cianferoni, S. Drugs (2010) 70: 1927. doi:10.2165/11538080-000000000-00000

Abstract

Ventilator-associated pneumonia (VAP) affects 10–20% of mechanically ventilated patients and is associated with increased morbidity and mortality and high costs. Early diagnosis is crucial for rapid appropriate antimicrobial therapy to be instituted, but debate remains as to the optimal diagnostic strategy. Noninvasive clinical-based diagnosis is rapid but may not be as accurate as invasive techniques. Increased use of biomarkers and advances in genomics and proteomics may help speed up diagnosis. Management of VAP relies principally on appropriate antimicrobial therapy, which should be selected according to individual patient factors, such as previous antibacterial therapy and length of hospitalization or mechanical ventilation, and local infection and resistance patterns. In addition, once bacterial culture and sensitivity results are available, broad-spectrum therapy should be de-escalated to provide a more specific, narrower-spectrum cover. Optimum duration of antibacterial therapy is difficult to define and should be tailored to clinical response. Biomarker levels may be useful to monitor response to therapy. With the high morbidity and mortality, prevention of VAP is important and several strategies have been shown to reduce the rates of VAP in mechanically ventilated patients, including using noninvasive ventilation where possible, and semi-recumbent positioning. Other potentially beneficial preventive techniques include subglottal suctioning, oral decontamination strategies and antimicrobial-coated endotracheal tubes, although further study is needed to confirm the cost effectiveness of these strategies.

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Jean-Louis Vincent
    • 1
  • Dalton de Souza Barros
    • 1
  • Silvia Cianferoni
    • 1
  1. 1.Department of Intensive Care, Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium