Management of ventilator-associated pneumonia: Need for a personalized approach

ABSTRACT

Introduction: Optimizing management of ventilator-associated pneumonia (VAP) should focus on the accurate identification of true lung infection, determination of the etiological agent, and early institution of adequate empirical therapy and de-escalation. Local adaptation of the standard guidelines leads to favorable outcome in the management of VAP

Areas covered: In this review, we present the concepts of early adequate therapy and the key considerations such as patient characters, clinical and etiological diagnosis, and assessment of patients for de-escalation that favor optimization of therapy. We highlight the issues that need a personalized approach in the management of VAP emphasizing on various patient categories for reassessment and tailoring the therapy.

Expert commentary: Rapid diagnostic techniques and non-invasive metabolomics will identify phenotypes which will shift the traditional paradigm based on conventional cultures. A personalized approach taking into account baseline resistance epidemiology, underlying disease (and comorbidities), duration of hospitalization, and prior antimicrobial exposure should guide targeted therapy.

KEYWORDS:

• Adequate therapy
• assessment
• personalized
• pneumonia
• ventilator

Declaration of interest

J Rello received honoraria by participation in consultancies and speaker’s bureau from Anchoagen, Pfizer and Thermo Fisher. No potential conflict of interest is reported by Vandana. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Integrated Cooperative Programme of Pneumonia, CIBERES CB06/06/036, Institute of Salud Carlos III, Madrid, Spain. This study has been developed as part of an Observership Programme of the ESCMID (Vandana).