Optimizing therapeutic approaches in ventilator-associated pneumonia.
The world-wide increasing of antimicrobial resistance, face the clinician with the dilemma of treating patients in excess or under-treat patients who need therapy. Early empirical therapy, based on local epidemiological and surveillance data, clinical presentation, timing of onset of pneumonia relative to hospital admission, and administration of prior antibiotics, is often necessary. The first-line therapy in patients with early-onset pneumonia, no risk factor and no prior antibiotics, will be direct to community type organisms, while in patients with late-onset (>5 to 7 days mechanical ventilation) pneumonia, and after prior administration of antibiotics, will be direct to multi-resistant and difficult-to-treat organisms. Risk for development of self-resistance appears higher with imipenem and fluoroquinolones. Obtaining reliable samples to adapt therapy does not improve outcome, but may allow withdrawing of therapy when pneumonia is not confirmed, therefore reducing the overall selective pressure in the ICU environment.
Brun-Buisson
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Medical ICU, Hôpital Henri-Mondor, Créteil, France.
D003422:Critical Care; D004352:Drug Resistance, Microbial; D006801:Humans; D011014:Pneumonia / Q000628:therapy*; D012122:Ventilators, Mechanical / Q000009:adverse effects*