Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impact on patient care

Abstract

Hospital-acquired pneumonia is a common nosocomial infection, with significant morbidity and mortality, and represents a major therapeutic challenge to clinicians. The therapeutic approach must be patient-oriented and institution-specific. The specific risk factors of each patient, such as previous antibiotic exposure, underlying diseases, length of hospital stay and the local patterns of antimicrobial resistance, should guide physicians in their decision of the initial optimal empirical therapy. Delays in the initiation or inappropriate/inadequate initial therapy are related to increased mortality and worse outcomes. In responding patients, as soon as culture data are available, efforts should be made to change the initial broad spectrum antibiotic regimen to a more targeted one (de-escalation). The optimal duration of treatment is a matter of debate, but courses longer than 1 week are rarely justified.

Keywords::

• hospital-acquired pneumonia
• ventilator-associated pneumonia

Acknowledgements

This work has been supported in part by: 2005/SGR/920, RED RESPIRA (isciii-RTIC 03/11), FISS PI05/2410. None of the authors have a conflict of interest.

Notes

cIAI: Complicated intra-abdominal infections; cSSSI: Complicated skin/skin-structures infection; ELF: Epithelial lining fluid (pulmonary); ESBL: Extended-spectrum β-lactamases; MIC: Minimum inhibitory concentration; MRSA: Methicillin-resistant Staphylococcus aureus; PBP_2a: Penicillin-binding protein 2a; TMP: Trimethoprim; VRE: Vancomycin-resistant enterococcus; VRSA: Vancomycin-resistant Staphylococcus aureus. Information from [77-85,118,124-130].

COPD: Chronic obstructive pulmonary disease; GCS: Glasgow coma score; MRSA: Methicillin-resistant Staphylococcus aureus; MSSA: Methicillin-sensitive Staphylococcus aureus; VAP: Vancomycin-associated pneumonia.

Information from: SANDIUMENGE A, DIAZ E, BODI M, RELLO J: Intensive Care Med (2003) 29(6):876-883 [36], with kind permission of Springer Science and Buisiness Media.