title: Management of ventilator-associated pneumonia caused by multiresistant bacteria.
abstract: OBJECTIVE
  The inappropriate choice of antibiotics (in nearly one third of episodes) is the most important risk factor for death. Traditionally, a narrow-spectrum drug was used first, and the most potent drugs were reserved for subsequent use.
  
  
  RESULTS
  As multidrug resistance increases in the intensive care unit in patients treated for nosocomial pneumonia, costs, mortality, and morbidity are rising. Although methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii are frequently considered together, they have different virulence, risk factors and susceptibilities, requiring different antimicrobial choices. Assessment of clinical resolution should be differentiated in the presence of acute lung injury. In the absence of biochemical markers, oxygenation and core temperature should guide therapeutic decisions.
  
  
  CONCLUSIONS
  As ventilator-associated pneumonia increases, empiric therapy should be based on local pathogen etiology and antibiotic resistant patterns. A new approach to consider is to start with a high-dose, broad-spectrum antibiotic and then tailor the individual therapy based on microbiological results and clinical resolution. With the use of broad-spectrum antibiotics available in empiric therapy tailored after reassessment of the patient, there is hope for reducing costs, length of stay and mortality whereas the emergence of resistance will be minimized.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili. Institut Pere Virgili, Tarragona. Spain. 29805eds@comb.es
authors.forename: Emili
authors.initials: E
authors.lastname: Diaz
authors.forename: Emma
authors.initials: E
authors.lastname: Muñoz
authors.forename: Kemal
authors.initials: K
authors.lastname: Agbaht
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D040981:Acinetobacter baumannii; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007362:Intensive Care Units; D016106:Methicillin Resistance; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents