Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) in Canada: treatment update and the role of new IV antimicrobials

ABSTRACT

Introduction

Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) continue to be common infections causing significant morbidity and mortality worldwide. The timely initiation of empiric antimicrobial therapy is essential. In this paper, we provide a focused expert opinion on the current and potential empiric antimicrobial treatment options in HABP and VABP in Canada influenced by antimicrobial resistance impacting the use of older agents as well as available new intravenous (IV) antimicrobials.

Areas covered

The authors discuss treatment options for HABP and VABP in Canada. In addition, we focus on the potential role of new IV antimicrobials recently introduced to Canada. A literature search of HABP and VABP treatments was performed via PubMed (up to March 2023), using the following key words: monotherapy, combination therapy, aminoglycosides, carbapenems, cephalosporins, fluoroquinolones, penicillins as well as amoxicillin/clavulanate, ceftobiprole, ceftolozane/tazobactam, dalbavancin, and fosfomycin.

Expert opinion

Empiric antimicrobial treatment for HABP and VABP in Canada continues to focus on both the severity of illness and the presence/absence of patient risk factors for antimicrobial resistance. The role of new IV antimicrobials in the empiric treatment for HABP and VABP depends on their antimicrobial activity and published data on efficacy and safety and influenced by Health Canada-approved indications.

KEYWORDS:

• combination therapy
• carbapenems
• cephalosporins
• fluoroquinolones
• amoxicillin/clavulanate
• ceftobiprole
• ceftolozane/tazobactam
• dalbavancin and fosfomycin

Article highlights

• Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) continue to be common infections causing significant morbidity and mortality around the globe.

• The timely initiation of appropriate empiric antimicrobial therapy in HABP and VABP is essential.

• Empiric antimicrobial treatment for HABP and VABP in Canada continues to focus on both the severity of illness and the presence/absence of patient risk factors for antimicrobial resistance.

• Despite resistance, older antimicrobials continue to have an important role to play in the empiric treatment for HABP and VABP.

• The role of new IV antimicrobials in the empiric treatment for HABP and VABP depends on their antimicrobial activity and published data on their efficacy and safety and is influenced by Health Canada-approved indications.

Declaration of interest

GG Zhanel has received research funding from Avir, Iterum, Merck & Co, Paladin labs, Pfizer Inc, Sandoz, Venatorx, Verity and Zambon. C. Rotstein has received honoraria from Avir Pharma and Merck Canada Inc. 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.

Author contributions

All authors have substantially contributed to the conception, design of the review article, interpreting the relevant literature and writing the review article.

Additional information

Funding

This paper was not funded.