title: Antibiotic therapy for ventilator-associated tracheobronchitis: a standard of care to reduce pneumonia, morbidity and costs?
abstract: OBJECTIVE
  The present review draws our attention to ventilator-associated tracheobronchitis (VAT) as a distinct clinical entity that has been associated with progression to ventilator-associated pneumonia (VAP) and worse patient outcomes. In contrast to VAP, which has been extensively investigated for over the past 30 years, most VAT studies have been conducted in the past decade. There are ample data which demonstrate that VAT may progress to VAP, have more ventilator days, and have longer ICU stay that may translate into higher healthcare costs.
  
  
  RESULTS
  The article focuses on the diagnostic criteria for VAT, causative agents, and studies analyzing associations between VAT and patient outcomes in relation to early, appropriate intravenous, and/or aerosolized antibiotic therapy. Aerosolized antibiotic treatment delivered by improved device technology is a novel approach that has proved to be effective for the treatment and eradication of multidrug-resistant bacterial pathogens. Aerosolized antibiotics are effective in decreasing the use of systemic antibiotics, reducing bacterial resistance, and may also facilitate clinical resolution of infection.
  
  
  CONCLUSIONS
  Evidence presented in this review supports treatment of VAT with early and appropriate antibiotic therapy as a standard of care to reduce VAP, ventilator days, and duration of ICU stay in high-risk patient population.
authors.affiliation: aCenter for Infectious Diseases Research & Prevention bDepartment of Surgical Critical Care, Lahey Hospital & Medical Center, Burlington cTufts University School of Medicine dTufts School of Medicine Public Health Program, Boston, Massachusetts, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Craven
authors.forename: Jana
authors.initials: J
authors.lastname: Hudcova
authors.forename: Jawad
authors.initials: J
authors.lastname: Rashid
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D006801:Humans; D009017:Morbidity; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D014136:Tracheitis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents