Hospital-acquired bacterial pneumonia in critically ill patients: from research to clinical practice

ABSTRACT

Introduction

Hospital-acquired pneumonia (HAP) represents a significant cause of mortality among critically ill patients admitted to Intensive Care Units (ICUs). Timely and precise diagnosis is imperative to enhance therapeutic efficacy and patient outcomes. However, the diagnostic process is challenged by test limitations and a wide-ranging list of differential diagnoses, particularly in patients exhibiting escalating oxygen requirements, leukocytosis, and increased secretions.

Areas covered

This narrative review aims to update diagnostic modalities, facilitating the prompt identification of nosocomial pneumonia while guiding, developing, and assessing therapeutic interventions. A comprehensive literature review was conducted utilizing the MEDLINE/PubMed database from 2013 to April 2024.

Expert opinion

An integrated approach that integrates clinical, microbiological, and imaging tools is paramount. Progress in diagnostic techniques, including novel molecular methods, the expanding utilization and accuracy of bedside ultrasound, and the emergence of Artificial Intelligence, coupled with an improved comprehension of lung microbiota and host-pathogen interactions, continues to enhance our capability to accurately and swiftly identify HAP and its causative agents. This advancement enables the refinement of treatment strategies and facilitates the implementation of precision medicine approaches.

KEYWORDS:

• Intensive care
• hospital mortality
• antibiotics
• sepsis
• shock
• MDR
• VAP

Article highlights

• Hospital-acquired pneumonia (HAP) is one of the most common infections among hospitalized patients, and it is the leading cause of death among critically ill patients.

• International guidelines indicate prompt and appropriate antibiotic therapy is the most critical determinant in reducing mortality.

• Rapid, accurate, and sensitive diagnostic tools are crucial for promptly identifying the infection, determining the pathogen, improving patient outcomes, and reducing broad-spectrum antibiotic therapy.

• Lung ultrasound (LUS) has shown promising results in diagnosing VAP. It offers a non-irradiating, point-of-care, and relatively inexpensive alternative to chest X-rays, with high sensitivity and specificity.

• Identifying suitable determinants of successful treatment for VAP from multi-drug resistant pathogens has also proven challenging.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.