Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: "thinking outside the box".
Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a meta-analysis have reported antibiotic treatment for VAT can reduce VAP, ventilator days, length of intensive care unit (ICU) stay, and patient morbidity and mortality. We discuss early diagnostic criteria, etiologic agents, and benefits of initiating, early, appropriate intravenous or aerosolized antibiotic(s) to treat VAT and reduce VAP, to improve patient outcomes by reducing lung damage, length of ICU stay, and healthcare costs.
Center for Infectious Diseases & Prevention, Lahey Hospital and Medical Center, 31 Mall Rd, Burlington, MA, 01805, USA. donald.e.craven@lahey.org.|Tufts University School of Medicine, Boston, MA, USA. donald.e.craven@lahey.org.
Donald E
DE
Craven
Surgical Critical Care, Lahey Hospital and Medical Center, Burlington, MA, USA.|Tufts University School of Medicine, Boston, MA, USA.
Jana
J
Hudcova
Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA.
Yuxiu
Y
Lei
New England Independent Review Board for Human Research, Wellesley, MA, USA.
Kathleen A
KA
Craven
Brookdale University Medical Center, Brooklyn, NY, USA.
Ahsan
A
Waqas
Antibiotic sensitivity; Bacterial pathogen virulence; Morbidity; Mortality and healthcare costs; Patient outcomes; Use of early appropriate antibiotic therapy; VAP prevention; Ventilator-associated pneumonia (VAP); Ventilator-associated respiratory infection (VARI); Ventilator-associated tracheobronchitis (VAT)
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