[Actualities of adults' ventilator-associated pneumonia].
Pneumonia is the most frequently reported nosocomial infection in intensive care unit patients, predominantly in mechanically ventilated individuals. Most of the studies performed in intensive care unit settings reported the estimated 15-65% of ventilator-associated pneumonia, with high mortality rates. Ventilator-associated pneumonia results in prolonged hospitalization and increase in medical care costs. In most cases, high-risk pathogens (e.g. Gram-negative bacteria, such as Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. with wide spectrum resistance, as well as methicillin-resistant Staphylococcus aureus) are the predominant causative agents of increased mortality. Occurrence of ventilator-associated pneumonia correlates with the duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), demographical factors and treatment. Effective antibiotic management programs provide the information on local patterns of antimicrobial resistance, therefore, the proper antibiotic therapy can be chosen empirically. Invasive management strategy reduces mortality, earlier prevents organ dysfunction and lower antibiotic consumption in patients with suspected ventilator-associated pneumonia. The major goal of ventilator-associated pneumonia management is to optimize antimicrobial therapy by administering correct antibiotics in adequate doses and avoiding the initial use of wide spectrum antimicrobials. The antibiotic therapy should depend on antimicrobial sensitivity testing results and the clinical patient's response. The duration of therapy should be shortened to the minimum effective period. Excessive antibiotic use is a major factor contributing to increased antibiotic-resistance of pathogens. Prevention of the ventilator-associated pneumonia by local multidisciplinary strategies may reduce mortality rates and is beneficiary both for the patients and the hospital system. The education of the nursing staff helps to decrease the occurrence of ventilator-associated pneumonia in intensive care unit setting. However, ventilator-associated pneumonia still remains a serious controversy-generating problem in intensive care unit.
Svediene
Saule
S
Clinic of Anesthesiology and Intensive Care, Vilnius University, Lithuania. saulyte71@yahoo.com
Ivaskevicius
Juozas
J
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000209:etiology* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D012121:Respiration, Artificial / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D000900:Anti-Bacterial Agents