Journal
EXPERT REVIEW OF RESPIRATORY MEDICINE
Volume 6, Issue 5, Pages 533-555Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1586/ERS.12.45
Keywords
Acinetobacter baumannii; antibacterial agents; artificial respiration; beta-lactamase; carbapenemase; critical illness; drug resistance; intensive care; intratracheal intubation; methicillin-resistant Staphylococcus aureus; Pseudomonas aeruginosa; ventilator-associated pneumonia
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Funding
- Pfizer
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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 Staphlococcus 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 beta-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antibimicrobial 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.
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