title: Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management.
abstract: OBJECTIVE
  The recent evidence is reviewed on clinical epidemiology, trends in bacterial resistance, diagnostic tools and therapeutic options in hospital-acquired pneumonia (HAP), with a special focus on ventilator-associated pneumonia (VAP).
  
  
  RESULTS
  The current incidence of VAP ranges from two to 16 episodes for 1000 ventilator-days, with an attributable mortality of 3-17%. Staphylococcus aureus (with 50-80% of methicillin-resistant strains), Pseudomonas aeruginosa and Enterobacteriaceae represent the most frequent pathogens in HAP/VAP. The prevalence of carbapenemase-producing Gram-negative bacilli (GNB) and the emergence of colistin resistance are alarming. Procalcitonin seems to have a good value to monitor the response to treatment. Rapid molecular tests for the optimization of empirical therapy will be available soon. Recent studies support the use of a high-dosing regimen of colistin in HAP/VAP caused by extensively drug-resistant GNB. Linezolid may probably be preferred to vancomycin for a subset of methicillin-resistant S. aureus HAP/VAP. Given the scarcity of novel antimicrobial drugs, different approaches such as bacteriophage therapy or immunotherapy warrant further clinical evaluations.
  
  
  CONCLUSIONS
  HAP/VAP is a major cause of deaths, morbidity and resources utilization, notably in patients with severe underlying conditions. The development of new diagnostic tools and therapeutic weapons is urgently needed to face the epidemic of multidrug-resistant pathogens.
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Source, Centre Hospitalier Régional d'Orléans, Orléans, France.
authors.forename: François
authors.initials: F
authors.lastname: Barbier
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017281:Cost of Illness; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015995:Prevalence; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents