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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
TREATING RESPIRATORY DISEASE
Lee C. P., Lim A. Y. H., Abisheganaden J.
Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
Ventilator associated pneumonia (VAP) causes significant morbidity and mortality worldwide. Incidence rate of VAP ranges from as low as zero in developed countries to as high as 40 per 1000 mechanical ventilation days in developing countries. Comparisons of VAP rates remain a challenge as VAP case definitions differ amongst countries. The top 6 pathogens including, Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter species, Klebsiella species, Serratia species and Acinetobacter species, accounted for the large majority of cases of VAP. Community acquired organisms and antibiotic-sensitive enteric gram-negative bacilli were common isolates in early VAP whereas methicillin-resistant Staphylococcus aureus and multi-drug resistant (MDR) gram negative bacilli predominate in late VAP. There has been an increased awareness in the pathogenesis of VAP that has renewed interest in the prevention of VAP. Diagnosis of VAP is guided by clinical criteria and microbiological data from invasive and non-invasive methods of respiratory specimen collection. Combination therapy is the mainstay of antimicrobial treatment in patients with risk factors for MDR organisms. Major changes since the publication of the 2005 American Thoracic Society/Infectious Disease Society of America guidelines on VAP are discussed in this review.