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Semin Respir Crit Care Med 2006; 27(1): 082-091
DOI: 10.1055/s-2006-933676
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Novel and Innovative Strategies to Treat Ventilator-Associated Pneumonia: Optimizing the Duration of Therapy and Nebulizing Antimicrobial Agents

Ivan Goldstein1 , Jean Chastre2 , Jean-Jacques Rouby1
  • 1Réanimation Chirurgicale Pierre Viars, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
  • 2Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
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Publication History

Publication Date:
01 March 2006 (online)

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ABSTRACT

Ventilator-associated pneumonia (VAP) is responsible for approximately half of the infections acquired in the intensive care unit (ICU) and represents one of the principal reasons for prescribing antibiotics in this setting. Because unnecessary prolongation of antimicrobial therapy and insufficient dosing of antibiotics at the site of infection in patients with true bacterial infection may lead to the selection of multidrug-resistant microorganisms without improving clinical outcome, efforts to reduce the duration of therapy and optimize pulmonary penetration of antimicrobial agents are warranted. An 8-day regimen can probably be standard for patients with VAP. Possible exceptions to this recommendation include immunosuppressed patients, those whose initial antimicrobial treatment was not appropriate for the causative microorganism(s), and patients whose infection was caused by very difficult-to-treat microorganisms and had no improvement in clinical signs of infection. Nebulizing concentration-dependent antibiotics such as aminoglycosides during mechanical ventilation can markedly increase tissue penetration in foci of pneumonia as compared with intravenous administration. The superiority in terms of pulmonary penetration and antibacterial efficacy of this route of administration was demonstrated in a model of ventilated piglets with and without bronchopneumonia.

KEYWORDS

Ventilator-associated pneumonia - quantitative cultures - antimicrobial treatment - duration of therapy - multidrug-resistant microorganisms - aerosols - piglets - amikacin

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Jean ChastreM.D. 

Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière

47, boulevard de l’Hôpital, 75651 Paris Cedex 13, France

Email: jean.chastre@psl.ap-hop-paris.fr

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