Current treatment of nosocomial pneumonia and ventilator-associated pneumonia

Abstract

Hospital-acquired pneumonia and ventilator-associated pneumonia are severe nosocomial infections leading to high morbidity and mortality. Broad-spectrum antibiotics with coverage against all likely pathogens are recommended by the international guidelines. Inappropriate empirical treatment is one of the most important prognostic factors. Knowledge of local epidemiology and continuous microbiological surveillance is crucial for improving clinical approaches to empirical antimicrobial treatment. The development of protocols and policies for training healthcare professionals on preventive strategies, such as the "Pneumonia Zero" project, and improved implementation of antimicrobial stewardship practices, will aid early de-escalation of antibiotics and prevent resistance.

Figure 1

Management of HAP, vHAP and VAP. Risk factors for MDR gram-negative bacilli: Local prevalence of >10%, unknown local epidemiology, septic shock, acute respiratory distress syndrome prior to VAP, renal replacement therapy, received antibiotics in the last 90 days, ≥ 5 days of hospital stay, known previous colonization (microbiological surveillance). Risk factors for MRSA: local prevalence >10-20%, unknown prevalence of MRSA, influenza infection.