The pathogenesis of ventilator-associated pneumonia: old and new mechanisms.

IF 2.7
Expert review of respiratory medicine Pub Date : 2025-07-01 Epub Date: 2025-04-16 DOI:10.1080/17476348.2025.2493366
Arnau Ulsamer, Sergio Bonilla, Xosé Pérez-Fernández, Jordi Rello, Joan Sabater-Riera
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Abstract

Introduction: Ventilator-associated pneumonia (VAP), defined as a lung infection that occurs in patients after 48 hours on mechanical ventilation, is among the most frequently found nosocomial infections in intensive care units around the world and is associated with increased morbidity, mortality, and economic burden.

Areas covered: We review the classical mechanisms of VAP development and explore more recent ones, such as dysbiosis, which has changed our view of the pathogenesis of the disease; whereas in the past the lower respiratory tract was classically considered a sterile organ, the use of new diagnostic techniques has shown that the lungs of healthy humans are inhabited by a large, dynamic ecosystem of microorganisms. Dysbiosis is the disruption of this ecosystem and is a key factor in the development of VAP. Recent findings have demonstrated that host immunity is microbiome-regulated and, consequently, is profoundly affected by dysbiosis. In this paper the significance of the microbiome-immunity crosstalk in the pathophysiology of VAP will be discussed.

Expert opinion: A deeper understanding of mechanisms of VAP pathogenesis should help to devise new preventive, diagnostic and therapeutic strategies for reducing the incidence of this condition and for improving patient prognosis.

呼吸机相关性肺炎的发病机制:新旧机制。
简介:呼吸机相关性肺炎(VAP)被定义为患者在机械通气48小时后发生的肺部感染,是世界各地重症监护病房最常见的院内感染之一,与发病率、死亡率增加和经济负担相关。涵盖的领域:我们回顾了VAP发展的经典机制,并探讨了最近的机制,如生态失调,这改变了我们对疾病发病机制的看法;在过去,下呼吸道通常被认为是无菌的器官,而新的诊断技术的使用表明,健康人的肺部居住着一个庞大的、动态的微生物生态系统。生态失调是这种生态系统的破坏,是VAP发展的关键因素。最近的研究结果表明,宿主免疫是由微生物组调节的,因此受到生态失调的深刻影响。本文将讨论微生物群-免疫串扰在VAP病理生理中的意义。专家意见:对VAP发病机制的深入了解有助于制定新的预防、诊断和治疗策略,以减少该病的发病率,改善患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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