Ventilator-associated pneumonia: Emerging principles of management

Current principles of management of ventilator-associated pneumonia (VAP) include early initiation of appropriate and adequate antibiotic therapy after blood and sputum are obtained for cultures. Quantitative distal airway sampling provides greater diagnostic specificity and, in one randomized study, achieved better outcomes than clinical diagnosis with qualitative endotracheal aspirates. High doses of initial empiric antibiotics are recommended to achieve maximal therapeutic effect. The patient's clinical response to empiric antibiotics is correlated with microbiologic results in order to streamline or de-escalate antibiotic therapy or to stop unnecessary drugs. Duration of therapy for uncomplicated VAP should be limited to 7 days, followed by close monitoring for relapse. For pneumonia secondary to infection with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus, a longer course of therapy may be indicated. Prevention strategies should target modifiable short- and long-term risk factors.