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Do guidelines change outcomes in ventilator-associated pneumonia?

Bassi, Gianluigi Li; Ferrer, Miguel; Saucedo, Lina M; Torres, Antoni

Current Opinion in Infectious Diseases: April 2010 - Volume 23 - Issue 2 - p 171–177
doi: 10.1097/QCO.0b013e328337241a
Respiratory infections: Edited by Michael S. Niederman

Purpose of review: The purpose of the study is to summarize effects of implementation of current and past guidelines for management and treatment of ventilator-associated pneumonia (VAP) on outcome of intensive care patients, with particular focus on etiology of VAP, pathogens prediction, appropriate empiric antibiotic therapy and mortality.

Recent findings: Several studies have shown that in patients with clinical suspicion of VAP, appropriate antibiotic therapy administered in a timely manner can improve survival. Guidelines for management and treatment of VAP have been developed to help physicians to achieve those goals. Implementation of guidelines into clinical practice is difficult to achieve and requires extensive education for healthcare personnel and translation of recommendations into local protocols. Studies have shown that guidelines implementation is associated with better outcome. However, extensive research needs to be undertaken in order to validate efficacy of guidelines in predicting etiology of pneumonia, in particular, to promptly identify multidrug-resistant pathogens. Only one recent report has validated the latest guidelines and called attention for further research to improve microbial prediction.

Summary: Guidelines implementation can improve outcomes. To achieve this goal, guidelines should be adapted to local microbiology, accurately predict VAP pathogens and help physicians to administer the most appropriate empirical antimicrobial therapy.

Department of Pneumology and Critical Care, Hospital Clinic, Thorax Institute, Barcelona, Spain

Correspondence to Professor Antoni Torres, MD, Servei de Pneumologia i Al·lèrgia Respiratòria, Hospital Clínic, 170 Villarroel Street, 6/8 2nd floor, 08036 Barcelona, Spain Tel: +34 932275549; fax: +34 932275549; e-mail: atorres@clinic.ub.es

© 2010 Lippincott Williams & Wilkins, Inc.