Emerging approaches to the treatment of ventilator-associated pneumonia

Author(s): B Mourvillier1, L Berra & J Wiener-Kronish

Despite aggressive prevention efforts, ventilator-associated pneumonia is still the most common nosocomial infection in intensive care units. It increases mortality and morbidity. Since the most recent guidelines published in 2007, few new antibiotics have emerged and clinicians are facing more and more resistant pathogens. This review summarizes recent advances in optimizing treatment such as continuous infusion of antibiotics such as β-lactams, inhalation of antibiotics and high-dose aminoglycosides. Treatment of methicillin resistant Staphylococcus aureus and carbapenem resistant Gram-negative organisms are discussed. Eight-day duration of antimicrobial treatment for most of the cases is now well established and may even be shortened with a procalcitonin-guided algorithm. Immunomodulation and immunotherapy are also reviewed. Despite the lack of large randomized trials, most of these therapies appear to be useful for critically ill patients.