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Research ArticleConference Proceedings

Conference Summary: Ventilator-Associated Pneumonia

Jean Chastre
Respiratory Care July 2005, 50 (7) 975-983;
Jean Chastre
Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France.
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Abstract

Ventilator-associated pneumonia (VAP), which is usually defined as an infection occurring greater than 48 hours after hospital admission in a patient requiring mechanical ventilation, is an entity that should be viewed as a subcategory of health-care-associated pneumonia, which includes any patient who was hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; resided in a nursing home or long-term care facility; received recent antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; or attended a hospital or hemodialysis clinic. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving mechanical ventilation. In contrast to infections of other frequently involved organs (eg, urinary tract and skin), for which mortality is low, the mortality rate for VAP ranges from 20% to 50% and can reach 70% in some specific settings or when lung infection is caused by high-risk pathogens and/or when initial antibiotic therapy is inappropriate. Although the attributable mortality rate for VAP is still debated, it has been shown that these infections prolong both the duration of ventilation and the duration of ICU stay. These prolonged hospitalizations underscore the considerable financial burden imposed by the development of VAP. The causes of VAP are many and may vary by hospital, patient population, and type of ICU, emphasizing the need for timely, local surveillance data. In many cases infection is caused by multiple-drug-resistant pathogens. Risk factors for such resistant microorganisms are the duration of mechanical ventilation, prior antibiotic treatment, and contact with the health care system. Preventive measures should be guided with regard to a full understanding of pathogenesis and epidemiology. Because respiratory-tract colonization of ICU patients is generally very complex, corresponding to a mix of self-colonization and cross-transmission, only a multifaceted and multidisciplinary program can be effective. Antimicrobial therapy of patients with VAP should follow a 2-stage process. The first stage involves administering broad-spectrum antibiotics to avoid inappropriate treatment in patients with true bacterial pneumonia. The second stage focuses on trying to achieve this objective without overusing and abusing antibiotics, combining a number of different steps, such as stopping therapy in patients with a low probability of the disease, streamlining treatment once the etiologic agent is known, switching to monotherapy after days 3–5, and shortening duration of therapy to 7–8 days, as dictated by the patient's clinical response to therapy and information about the bacteriology of the infection.

  • ventilator-associated pneumonia
  • health care-associated pneumonia
  • epidemiology
  • multiple-drug-resistant microorganisms
  • prevention
  • fiberoptic bronchoscopy
  • bronchoalveolar lavage
  • quantitative culture techniques
  • antimicrobial therapy

Footnotes

  • Correspondence: Jean Chastre MD, Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 43–87 bd de l'Hôpital, 75651 Paris Cedex 13, France. E-mail: jean.chastre{at}psl.ap-hop-paris.fr.
  • Jean Chastre 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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Conference Summary: Ventilator-Associated Pneumonia
Jean Chastre
Respiratory Care Jul 2005, 50 (7) 975-983;

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Conference Summary: Ventilator-Associated Pneumonia
Jean Chastre
Respiratory Care Jul 2005, 50 (7) 975-983;
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Keywords

  • Ventilator-associated pneumonia
  • health care-associated pneumonia
  • epidemiology
  • multiple-drug-resistant microorganisms
  • prevention
  • fiberoptic bronchoscopy
  • bronchoalveolar lavage
  • quantitative culture techniques
  • antimicrobial therapy

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