Antibiotic therapy of ventilator-associated pneumonia—a reappraisal of rationale in the era of bacterial resistance

AbstractObjective:To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients.Methods:This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions.Results:Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP.Conclusions:The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

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Comparison of 8 versus 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0042 ◽

2018 ◽

pp. 257-262

Author(s):

Laurie O. Mark ◽

Jean Kwo

Keyword(s):

Antibiotic Therapy ◽

Randomized Trial ◽

Study Design ◽

Clinical Case ◽

Pulmonary Infection ◽

Ventilator Associated Pneumonia ◽

Icu Patients ◽

Study Intervention ◽

Landmark Study

This chapter provides a summary of the landmark study “Comparison of 8 versus 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.” In adult patients with ventilator-associated pneumonia (VAP), is treatment with an 8-day course of antimicrobials as effective as a 15-day course? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. In ICU patients who develop microbiologically proven VAP, an 8-day antimicrobial course is not inferior to a 15-day course with respect to all-cause mortality or recurrence of pulmonary infection. However, these findings may not apply to patients who are immunocompromised, and shorter or longer duration of antibiotics may sometimes be indicated.

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Adhering to the procalcitonin algorithm allows antibiotic therapy to be shortened in patients with ventilator-associated pneumonia

Journal of Critical Care ◽

10.1016/j.jcrc.2019.05.022 ◽

2019 ◽

Vol 53 ◽

pp. 125-131 ◽

Cited By ~ 3

Author(s):

Florence Beye ◽

Clara Vigneron ◽

Auguste Dargent ◽

Sébastien Prin ◽

Pascal Andreu ◽

...

Keyword(s):

Antibiotic Therapy ◽

Ventilator Associated Pneumonia

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C-reactive protein correlates with bacterial load and appropriate antibiotic therapy in suspected ventilator-associated pneumonia

Critical Care Medicine ◽

10.1097/01.ccm.0000297886.32564.cf ◽

2008 ◽

Vol 36 (1) ◽

pp. 166-171 ◽

Cited By ~ 55

Author(s):

Thiago Lisboa ◽

Renato Seligman ◽

Emili Diaz ◽

Alejandro Rodriguez ◽

Paulo J. Z. Teixeira ◽

...

Keyword(s):

Antibiotic Therapy ◽

Bacterial Load ◽

Ventilator Associated Pneumonia ◽

C Reactive Protein ◽

Reactive Protein

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Avoiding ventilator-associated pneumonia: Curcumin-functionalized endotracheal tube and photodynamic action

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2006759117 ◽

2020 ◽

Vol 117 (37) ◽

pp. 22967-22973

Author(s):

Amanda C. Zangirolami ◽

Lucas D. Dias ◽

Kate C. Blanco ◽

Carolina S. Vinagreiro ◽

Natalia M. Inada ◽

...

Keyword(s):

Endotracheal Tube ◽

Bacterial Infections ◽

Bacterial Resistance ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Ventilator Associated Pneumonia ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Hospitalization Costs ◽

Hospital Acquired

Hospital-acquired infections are a global health problem that threatens patients’ treatment in intensive care units, causing thousands of deaths and a considerable increase in hospitalization costs. The endotracheal tube (ETT) is a medical device placed in the patient’s trachea to assist breathing and delivering oxygen into the lungs. However, bacterial biofilms forming at the surface of the ETT and the development of multidrug-resistant bacteria are considered the primary causes of ventilator-associated pneumonia (VAP), a severe hospital-acquired infection for significant mortality. Under these circumstances, there has been a need to administrate antibiotics together. Although necessary, it has led to a rapid increase in bacterial resistance to antibiotics. Therefore, it becomes necessary to develop alternatives to prevent and combat these bacterial infections. One possibility is to turn the ETT itself into a bactericide. Some examples reported in the literature present drawbacks. To overcome those issues, we have designed a photosensitizer-containing ETT to be used in photodynamic inactivation (PDI) to avoid bacteria biofilm formation and prevent VAP occurrence during tracheal intubation. This work describes ETT’s functionalization with curcumin photosensitizer, as well as its evaluation in PDI against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. A significant photoinactivation (up to 95%) against Gram-negative and Gram-positive bacteria was observed when curcumin-functionalized endotracheal (ETT-curc) was used. These remarkable results demonstrate this strategy’s potential to combat hospital-acquired infections and contribute to fighting antimicrobial resistance.

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