title: Delivering antibiotics to the lungs of patients with ventilator-associated pneumonia: an update.
abstract: Ventilator-associated pneumonia is a serious hospital-acquired infection, with 20-70% crude mortality and 10-40% estimated attributable mortality. Insufficient antibiotic concentrations at the infection site when these drugs are given intravenously may lead to poor outcomes, particularly when difficult-to-treat pathogens are responsible; for example, Pseudomonas aeruginosa, extended spectrum beta lactamase-producing Gram-negative bacilli, Acinetobacter spp. and/or methicillin-resistant Staphylococcus aureus. Direct drug delivery to the infection site via aerosolization combined with intravenous administration achieves concentrations exceeding MICs of the pathogens, even those with impaired susceptibility. Experimental and recent clinical results demonstrated our markedly improved ability to deliver aerosolized antibiotics to the lung with new-generation devices, for example, vibrating-mesh nebulizers. Convincing clinical data from a large randomized trial are still lacking to support the routine administration of aerosolized antibiotics to treat ventilator-associated pneumonia, even though some small-randomized trials' observations are encouraging.
authors.affiliation: Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. charles-edouard.luyt@psl.aphp.fr
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000254:growth & development; D000281:Administration, Intranasal / Q000295:instrumentation / Q000379:methods*; D061605:Administration, Intravenous; D000336:Aerosols / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D009330:Nebulizers and Vaporizers; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development; D016032:Randomized Controlled Trials as Topic
chemical_list: D000336:Aerosols; D000900:Anti-Bacterial Agents