Review
English
Zew MH, Jauoda KH
Department of Medicine, Faculty of Medicine, Al-Arab University for Medical Sciences. Benghazi, Libya.
Libyan J Infect Dis. 2009;3(1):13-27
Abstract
Ventilator-associated pneumonia (VAP) is a major cause of mortality in the critically ill intensive care unit patients. Physicians in charge of mechanically ventilated patients have to identify patients with true bacterial lung infection, to select appropriate initial antibiotic therapy, to adjust therapy as soon as possible, and to withhold antibiotics in patients without pneumonia. Appropriateness of initial antimicrobial therapy is probably the most important prognostic factor for patients with VAP. The choice of initial empiric antibiotic should be based on the patient`s previous antibiotic exposure, the duration of mechanical ventilation, and local antibiotic susceptibility patterns, which should be updated regularly. Reliable pulmonary specimens must be obtained for direct examination and cultures before initiation or modification of antibiotic treatment. An invasive diagnostic approach, such as the use of a protected specimen brush (PSB) or bronchoalveolar lavage (BAL), is usually advocated. However, optimal sampling technique (bronchoscopic vs nonbronchoscopic) is still a matter of debate. In the first part of this article we reviewed epidemiology, microbiology, pathogenesis, and prevention of VAP. The diagnosis and management of this common and serious disorder are discussed here.
Keywords: Ventilator-associated pneumonia; nosocomial pneumonia; nosocomial infection; bronchoscopy; antimicrobial therapy; mechanical ventilation.
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