title: Current concepts in the prevention and treatment of ventilator-associated pneumonia.
abstract: Ventilator-associated pneumonia (VAP) is one of the most common causes of infection in intensive care unit (ICU) patients. Efforts to prevent VAP have focused on both pharmacologic and nonpharmacologic strategies. Two of the more controversial pharmacologic approaches included selective decontamination of the digestive tract (SDD) and decontamination of the oropharynx using topical antimicrobials or antiseptics including chlorhexidine (CHX). Additionally, avoidance of pharmacotherapy-related risk factors is hypothesized to reduce VAP rates. Successful treatment of VAP is becoming increasingly difficult in the era of antibiotic resistance. Utilization of local antibiograms, implementation of standardized treatment pathways, and optimization of pharmacodynamic-based dosing offer methods to improve empiric therapy selections. De-escalation of therapy should be a constant focus in an attempt to reduce overall antibiotic consumption and the selection pressure on ICU flora, thus minimizing the development and spread of antimicrobial resistance in the ICU.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO 63110, USA. stm8241@bjc.org
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Lee P
authors.initials: LP
authors.lastname: Skrupky
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods; D003428:Cross Infection / Q000188:drug therapy / Q000517:prevention & control*; D004352:Drug Resistance, Microbial / Q000187:drug effects / Q000502:physiology; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents