Could invasive diagnostic techniques for ventilator-associated pneumonia be associated with reduced antibiotic usage in the ICU?
ICUs are often viewed as the epicenter of bacterial resistance. Overuse of antibiotics is one factor associated with this characteristic; other such factors include overcrowding, suboptimal observance of hygienic practices, cross-transmission of resistant strains, and high susceptibility of patients housed in ICUs. Evidence is scarce that different approaches to diagnosing infections, especially of the lower respiratory tract, can influence overall patterns of antibiotic usage and resistance. However, it is likely that more antibiotics are being administered to patients with suspected respiratory tract infections when diagnosed using nonspecific techniques than when more specific techniques are being used routinely. Additionally, the evidence is mounting that prior antibiotic usage is associated with increased risk of lower respiratory tract infection (LRTI), and also of infection caused by high-risk antibiotic-resistant pathogens, which in turn are associated with higher risk of treatment failure and mortality than their susceptible counterparts. A logical approach that may partially resolve this problem is to use specific diagnostic techniques, which will result in avoiding overtreating patients with suspected LRTI.
Brun-Buisson
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Université Paris-Val de Marne, Service de Réanimation Médicale, France.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006801:Humans; D007362:Intensive Care Units; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000175:diagnosis
D000900:Anti-Bacterial Agents