Hospital-acquired respiratory tract infections:: Clinical experience with β-lactam/β-lactamase inhibitors

The treatment of nosocomial pneumonia presents a major treatment challenge and one complicated by the rising prevalence of multidrug resistance among nosocomial pathogens. Contemporary treatment strategies for nosocomial pneumonia, which is most often attributable to Gram-negative bacilli or Staphylococcus aureus, mandate early empiric therapy with broad-spectrum antibacterial agents. The choice of agents for empiric therapy is fundamental to outcome, and the selection of inappropriate agents, to which pathogens are resistant, contributes significantly to morbidity and mortality. The adoption of practice guidelines, such as those proposed by the American Thoracic Society, can help to guide antibiotic selection, especially when combined with knowledge of local patterns of infection and antimicrobial susceptibility. beta-Lactam/beta-lactamase inhibitor combinations, particularly those with activity against Pseudomonas aeruginosa, are among the core antibiotic agents considered suitable for empiric therapy of nosocomial pneumonia. They are particularly suited to use in hospitals with high rates of beta-lactamase-mediated resistance, especially resistance due to extended-spectrum beta-lactamases, infections with Acinetobacter spp. and those of mixed aetiology.