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Research ArticleConference Proceedings

Antimicrobial Treatment of Ventilator-Associated Pneumonia

David R Park
Respiratory Care July 2005, 50 (7) 932-955;
David R Park
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
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Abstract

Ventilator-associated pneumonia is a common complication of ventilatory support for patients with acute respiratory failure and is associated with increased morbidity, mortality, and costs. Optimal antimicrobial therapy is an essential part of successful management of ventilator-associated pneumonia. Numerous safe and effective antimicrobial drugs are available, and their efficacy can be optimized by attention to basic pharmacokinetic and pharmacodynamic principles. An adequate initial empiric antimicrobial regimen is essential, because inadequate initial therapy is consistently associated with increased mortality. This regimen must be selected before final microbiology results become known, but likely pathogens and antimicrobial resistance patterns can be predicted based on published guidelines, patient-specific factors, and local epidemiologic data. Nevertheless, the initial regimen must often be broad-spectrum and typically requires combination therapy, with 2 or 3 different drugs, if there are risk factors for multidrug-resistant pathogens. The antimicrobial regimen can be narrowed or discontinued as culture and susceptibility results permit. This deescalation strategy ensures adequate initial antimicrobial therapy for most patients but lessens unnecessary antimicrobial exposure. The best diagnostic approach used to guide therapy, the optimum duration of therapy, and the roles of combination therapy, rotating therapy, and unconventional approaches to antimicrobial therapy all remain uncertain.

  • ventilator-associated pneumonia
  • mechanical ventilation
  • treatment
  • nosocomial
  • pneumonia
  • antibiotic
  • antimicrobial
  • antibiotic-resistant
  • antimicrobial-resistant
  • pharmacokinetic
  • pharmacodynamic
  • review

Footnotes

  • Correspondence: David R Park MD, Harborview Medical Center, Box 359762, 325 9th Avenue, Seattle WA 98104. E-mail: drp{at}u.washington.edu.
  • David R Park MD presented a version of this article at the 35th Respiratory Care Journal Conference, Ventilator-Associated Pneumonia, held February 25–27, 2005, in Cancún, Mexico.

  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (7)
Respiratory Care
Vol. 50, Issue 7
1 Jul 2005
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Antimicrobial Treatment of Ventilator-Associated Pneumonia
David R Park
Respiratory Care Jul 2005, 50 (7) 932-955;

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Antimicrobial Treatment of Ventilator-Associated Pneumonia
David R Park
Respiratory Care Jul 2005, 50 (7) 932-955;
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Keywords

  • ventilator-associated pneumonia
  • mechanical ventilation
  • treatment
  • nosocomial
  • pneumonia
  • antibiotic
  • antimicrobial
  • antibiotic-resistant
  • antimicrobial-resistant
  • pharmacokinetic
  • pharmacodynamic
  • review

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