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Microbial cause of ICU-acquired pneumonia

hospital-acquired pneumonia versus ventilator-associated pneumonia

Luyt, Charles-Edouarda,b; Hékimian, Guillaumea,b; Koulenti, Despoinac,d; Chastre, Jeana,b

Current Opinion in Critical Care: October 2018 - Volume 24 - Issue 5 - p 332–338
doi: 10.1097/MCC.0000000000000526
INFECTIOUS DISEASES: Edited by Antoni Torres

Purpose of review Successful treatment of patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remains a difficult and complex undertaking. Better knowledge of the pathogens involved in that setting may allow reassessment of our current modalities of therapy and definition of better protocols.

Recent findings Microorganisms responsible for HAP/VAP differ according to geographic areas, ICU patients’ specific characteristics, durations of hospital and ICU stays before onset of the disease, and risk factors for MDR pathogens. However, a number of studies have shown that Gram-negative bacilli (GNB) – particularly Pseudomonas aeruginosa and Enterobacteriaceae – cause many of the respiratory infections in this setting, with minimal differences between HAP and VAP, indicating that the cause depends more on the underlying clinical condition of patients rather than previous intubation.

Summary When selecting initial antimicrobial therapy in patients with HAP/VAP, more attention should be paid to individual risk factors for MDR pathogens, severity of the clinical situation, and the local epidemiology than to the type of pneumonia.

aService de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, 47-83 boulevard de l’Hôpital

bSorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France

c2nd Critical Care Department, ’Attiko’ University Hospital, Athens, Greece

dBurns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia

Correspondence to Jean Chastre, MD, Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, 47-83 boulevard de l’Hôpital, 75651 Paris Cedex 13, France. Tel: +33 1 42 16 38 22; fax: +33 1 42 16 38 17; e-mail: jean.chastre@aphp.fr

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