title: Ventilator-associated pneumonia caused by ESKAPE organisms:  cause, clinical features, and management.
abstract: OBJECTIVE
  Despite important geographical variations, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species (ESKAPE) pathogens constitute more than 80% of ventilator-associated pneumonia (VAP) episodes. Their clinical importance relies on their virulence and ability in developing mechanisms to decrease susceptibility to antimicrobials, increasing inappropriate therapy and affecting negatively on ICU patients' outcome. This review updates information on VAP due to ESKAPE pathogens.
  
  
  RESULTS
  Although methicillin-resistant Staphylococcus aureus VAP may be clinically similar to that caused by susceptible strains, it is associated with poorer outcomes despite adequate treatment. Local colonization determines treatment options. The contribution of tracheobronchitis is an important issue. Minimum inhibitory concentration should be considered for nonfermentative Gram-negative bacteria VAP to prescribe extended infusion β-lactam treatment due to an increase of resistant strains. Strategies promoting antimicrobial diversity may protect against emergence and spread of resistance by ESKAPE pathogens.
  
  
  CONCLUSIONS
  VAP due to ESKAPE pathogens represents a global challenge that can be prevented using stewardship programmes promoting diversity.
authors.affiliation: University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, CIBERES, Tarragona, Spain. asandiumenge@yahoo.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandiumenge
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016984:Enterococcus faecium; D006090:Gram-Negative Bacteria; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents