Pseudomonas aeruginosa ventilator-associated pneumonia management

Abstract

Ventilator-associated pneumonia is the most common infection in intensive care unit patients associated with high morbidity rates and elevated economic costs; Pseudomonas aeruginosa is one of the most frequent bacteria linked with this entity, with a high attributable mortality despite adequate treatment that is increased in the presence of multiresistant strains, a situation that is becoming more common in intensive care units. In this manuscript, we review the current management of ventilator-associated pneumonia due to P. aeruginosa, the most recent antipseudomonal agents, and new adjunctive therapies that are shifting the way we treat these infections. We support early initiation of broad-spectrum antipseudomonal antibiotics in present, followed by culture-guided monotherapy de-escalation when susceptibilities are available. Future management should be directed at blocking virulence; the role of alternative strategies such as new antibiotics, nebulized treatments, and vaccines is promising.

Keywords: ICU; adjunctive-therapies; care-bundles; multidrug-resistant; new-antibiotics.

Figure 1

Management of PA VAP. Notes: Carbapenems are usually reserved for MDR or polymicrobial infections. Aminoglycosides should be avoided as monotherapy despite antimicrobial susceptibility given its poor performance in lung tissue. High-dose inhaled colistin: 5 million units every 8 hours. Abbreviations: COPD, chronic obstructive pulmonary disease; MDR, multidrug-resistant; PA, Pseudomonas aeruginosa; PK/PD, pharmacokinetic/pharmacodynamic; VAP, ventilator-associated pneumonia; XDR, extensively drug resistant; ICU, intensive care unit.