Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens

Abstract

Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphlococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antibimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.

Keywords::

• Acinetobacter baumannii
• antibacterial agents
• artificial respiration
• β-lactamase
• carbapenemase
• critical illness
• drug resistance
• intensive care
• intratracheal intubation
• methicillin-resistant Staphylococcus aureus
• Pseudomonas aeruginosa
• ventilator-associated pneumonia

Acknowledgements

The authors thank Carol Spencer, medical librarian, for her assistance with literature searches and obtaining references; Elizabeth O’Gara, infectious disease pharmacist, for her critical review, and Vinald Frances for his work in developing Figure 3.

Financial & competing interests disclosure

DE Craven has received grant support from Pfizer and has been on the speakers bureau for Merck, Covidien and Sanofi-Pasteur. 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.

No writing assistance was utilized in the production of this manuscript.