title: Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens.
abstract: Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphylococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antiimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.
authors.affiliation: Department of Pharmacy, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Grgurich
authors.forename: Jana
authors.initials: J
authors.lastname: Hudcova
authors.forename: Yuxiu
authors.initials: Y
authors.lastname: Lei
authors.forename: Akmal
authors.initials: A
authors.lastname: Sarwar
authors.forename: Donald E
authors.initials: DE
authors.lastname: Craven
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D019317:Evidence-Based Medicine; D006801:Humans; D016867:Immunocompromised Host; D008134:Long-Term Care; D008826:Microbial Sensitivity Tests; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents