Ventilator-associated pneumonia.
OBJECTIVE
This review summarises some of the notable papers on ventilator-associated pneumonia (VAP) from January 2003 to October 2004.


RESULTS
Ventilator-associated pneumonia remains an important drain on hospital resources. All population groups are affected, but patients with VAP are more likely to be older, sicker, and male, with invasive medical devices in situ. Early VAP diagnosis is desirable to reduce VAP mortality and to retard emergence of multidrug-resistant microbes. This may be possible using preliminary culture results or intracellular organism in polymorphonuclear cells. In most intensive care units, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii are the commonest organisms isolated in VAP. However, causative organisms vary between and within hospitals. Consequently, individual intensive care units should develop empirical antibiotic policies to target the pathogenic bacteria prevalent in their patient populations. Preventative strategies aimed at reducing aerodigestive tract colonisation by pathogenic organisms, and also their subsequent aspiration, are becoming increasingly important. Educating medical staff about these simple measures is therefore pertinent. To reduce the occurrence of multidrug-resistant organisms, limiting the duration of antibiotic treatment to 8 days and antimicrobial rotation should be contemplated. Empirical therapy with antipseudomonal penicillins plus beta-lactamase inhibitors should be considered. If methicillin-resistant Staphylococcus aureus VAP is a possibility, linezolid may be better than vancomycin.


CONCLUSIONS
Prevention remains the key to reducing VAP prevalence.
Shaw
Michael Jan
MJ
Department of Anaesthetics, National Hospital for Neurology and Neurosurgery, London, UK. michael.shaw@ukonline.co.uk
D000900:Anti-Bacterial Agents; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D000900:Anti-Bacterial Agents