Do guidelines change outcomes in ventilator-associated pneumonia?
OBJECTIVE
The purpose of the study is to summarize effects of implementation of current and past guidelines for management and treatment of ventilator-associated pneumonia (VAP) on outcome of intensive care patients, with particular focus on etiology of VAP, pathogens prediction, appropriate empiric antibiotic therapy and mortality.


RESULTS
Several studies have shown that in patients with clinical suspicion of VAP, appropriate antibiotic therapy administered in a timely manner can improve survival. Guidelines for management and treatment of VAP have been developed to help physicians to achieve those goals. Implementation of guidelines into clinical practice is difficult to achieve and requires extensive education for healthcare personnel and translation of recommendations into local protocols. Studies have shown that guidelines implementation is associated with better outcome. However, extensive research needs to be undertaken in order to validate efficacy of guidelines in predicting etiology of pneumonia, in particular, to promptly identify multidrug-resistant pathogens. Only one recent report has validated the latest guidelines and called attention for further research to improve microbial prediction.


CONCLUSIONS
Guidelines implementation can improve outcomes. To achieve this goal, guidelines should be adapted to local microbiology, accurately predict VAP pathogens and help physicians to administer the most appropriate empirical antimicrobial therapy.
Department of Pneumology and Critical Care, Hospital Clinic, Thorax Institute, Barcelona, Spain.
Gianluigi Li
GL
Bassi
Miguel
M
Ferrer
Lina M
LM
Saucedo
Antoni
A
Torres
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D017408:Guidelines as Topic; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents