Nosocomial and Ventilator-associated Pneumonia

Q4 Medicine
Carlos Cabanillas Díez-Madroñero , Beatriz Raboso Moreno , Blanca Urrutia-Royo , Imanol González Muñoz , Marta Erro Iribarren , Cristina Pou Álvarez , Jessica González Gutiérrez
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引用次数: 0

Abstract

Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.
医院性和呼吸机相关性肺炎
院内性肺炎(NP),包括其亚型呼吸机相关性肺炎(VAP),是住院患者发病率、死亡率和医疗保健使用率增加的主要原因,特别是在重症监护环境中。这篇全面的问答式综述综合了目前关于NP和VAP的流行病学、病理生理学和管理的证据,重点是多药耐药生物(mdro)。在微生物谱、诊断方法和治疗意义方面,探讨了NP和VAP之间的关键区别。这篇综述详细分析了MDROs的危险因素,包括延长机械通气时间、既往抗生素暴露和宿主相关免疫抑制,强调了风险分层在指导经验性抗生素选择中的重要性。对国际指南建议(IDSA/ATS, ERS, SEPAR)的批判性评估突出了共识和分歧的领域,特别是关于经验性治疗策略和窄谱与广谱覆盖的作用。深入讨论了多重PCR等快速分子诊断工具的整合,包括它们提高诊断率、促进早期降级和加强抗菌药物管理的潜力。综述了抗菌药物的最新进展,包括新型β-内酰胺/β-内酰胺酶抑制剂组合和具有抗ESBL -, KPC -和碳青霉烯酶产生病原体活性的铁载体头孢菌素。它们在危重患者中的适当使用是在药代动力学/药效学优化的框架内进行的。最后,该综述审查了目前关于治疗时间的证据,支持在大多数情况下7-8天疗程,并在选定的高危人群中个体化延长疗程。还讨论了降钙素原作为生物标志物指导抗生素停药的效用。本综述为临床医生在抗微生物药物耐药性时代管理院内肺炎所需的复杂决策提供了简明的、基于证据的参考。
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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来源期刊
Open Respiratory Archives
Open Respiratory Archives Medicine-Pulmonary and Respiratory Medicine
CiteScore
1.10
自引率
0.00%
发文量
58
审稿时长
51 days
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