A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment

Current Infectious Disease Reports

Volumn 17, Issue 8, 2015, Pages

  Waters, Braden ^a   Muscedere, John ^a  

^a QUEEN S UNIVERSITY   (Canada)

Author keywords

Biomarkers; Infection related ventilator associated conditions (iVACs); Linezolid; Nosocomial infections in the ICU; Vancomycin; VAP; Ventilator associated conditions (VACs); Ventilator associated events (VAEs); Ventilator associated pneumonia

Indexed keywords

AMINOGLYCOSIDE ANTIBIOTIC AGENT; AMINOPENICILLIN; ANTIBIOTIC AGENT; AZTREONAM; BETA LACTAMASE INHIBITOR; CARBAPENEM; CEPHALOSPORIN; INTERLEUKIN 1BETA; INTERLEUKIN 8; LINEZOLID; PENICILLIN DERIVATIVE; PROBIOTIC AGENT; PROCALCITONIN; QUINOLINE DERIVED ANTIINFECTIVE AGENT; TRIGGERING RECEPTOR EXPRESSED ON MYELOID CELLS 1; VANCOMYCIN;

ARTIFICIAL VENTILATION; BACTERIUM CULTURE; BACTERIUM DETECTION; BRONCHOSCOPY; CALCITONIN BLOOD LEVEL; CLINICAL FEATURE; COUGHING; CRACKLE; CRITICALLY ILL PATIENT; ENDOTRACHEAL TUBE; EQUIPMENT DESIGN; ESOPHAGUS FOREIGN BODY; FEVER; GRAM NEGATIVE BACTERIUM; GRAM POSITIVE BACTERIUM; HUMAN; INFECTION PREVENTION; LEUKOCYTOSIS; LEUKOPENIA; LUNG GAS EXCHANGE; LUNG INFILTRATE; LUNG LAVAGE; MICROBIAL DIVERSITY; MOUTH HYGIENE; NONINVASIVE VENTILATION; PATHOPHYSIOLOGY; PATIENT POSITIONING; POSITIVE END EXPIRATORY PRESSURE; PREDICTIVE VALUE; PROCESS DESIGN; PROTEIN BLOOD LEVEL; PROTEIN EXPRESSION; REVIEW; SPUTUM ANALYSIS; THORAX RADIOGRAPHY; VENTILATOR ASSOCIATED PNEUMONIA;

EID: 84932630375     PISSN: 15233847     EISSN: 15343146     Source Type: Journal    
DOI: 10.1007/s11908-015-0496-3     Document Type: Review

References (68)

1. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274(8):639–44.
2. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433–40.
3. Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Anttila A, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control. 2013;41(4):286–300.
4. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71.
5. Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vesin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184(10):1133–9.
6. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184–93.
7. Restrepo MI, Anzueto A, Arroliga AC, Afessa B, Atkinson MJ, Ho NJ, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol. 2010;31(5):509–15.
8. Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care. 2008;23(1):5–10.
9. Yang CC, Shih NC, Chang WC, Huang SK, Chien CW. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study. BMC Health Serv Res. 2011;11:289.
10. Zolfaghari PS, Wyncoll DL. The tracheal tube: gateway to ventilator-associated pneumonia. Crit Care. 2011;15(5):310.
11. Rubin BK, Dhand R, Ruppel GL, Branson RD, Hess DR. Respiratory care year in review 2010: part 1. Asthma, COPD, pulmonary function testing, ventilator-associated pneumonia. Respir Care. 2011;56(4):488–502.
12. D’Haese J, De Keukeleire T, Remory I, Van Rompaey K, Umbrain V, Poelaert J. Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing? Acta Anaesthesiol Scand. 2013;57(7):873–80.
13. Conway Morris A, Anderson N, Brittan M, Wilkinson TS, McAuley DF, Antonelli J, et al. Combined dysfunctions of immune cells predict nosocomial infection in critically ill patients. Br J Anaesth. 2013;111(5):778–87.
14. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903.
15. Quartin AA, Scerpella EG, Puttagunta S, Kett DH. A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1184 patients from a large, international study. BMC Infect Dis. 2013;13:561.
16. Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013;7(11):2462–6.
17. Charles MP, Easow JM, Joseph NM, Ravishankar M, Kumar S, Sivaraman U. Aetiological agents of ventilator-associated pneumonia and its resistance pattern - a threat for treatment. Australas Med J. 2013;6(9):430–4.
18. Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, et al. Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med. 2013;39(4):672–81.
19. Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013;58(7):1220–5. Study demonstrating that multi-drug resistant organisms can be found in both early and late VAP isolates, whereas previously, these organisms were thought to be primarily found in late VAP.
20. Chi SY, Kim TO, Park CW, Yu JY, Lee B, Lee HS, et al. Bacterial pathogens of ventilator associated pneumonia in a tertiary referral hospital. Tuberc Respir Dis. 2012;73(1):32–7.
21. Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153(1):343–9.
22. Rello J, Torres A, Ricart M, Valles J, Gonzalez J, Artigas A, et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med. 1994;150(6 Pt 1):1545–9.
23. Klompas M. Does this patient have ventilator-associated pneumonia? JAMA. 2007;297(14):1583–93.
24. Hansen S, Sohr D, Geffers C, Astagneau P, Blacky A, Koller W, et al. Concordance between European and US case definitions of healthcare-associated infections. Antimicrob Resist Infect Control. 2012;1(1):28.
25. Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care. 2013;58(6):990–1007.
26. Tejerina E, Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu J, Ballesteros D, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care. 2010;25(1):62–8.
27. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143(5 Pt 1):1121–9.
28. Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011;56(8):1087–94.
29. Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101(2):458–63.
30. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis. 2013;26(2):140–50.
31. Berton DC, Kalil AC, Teixeira PJ. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD006482.
32. Raoof S, Baumann MH. An official multi-society statement: ventilator-associated events: the new definition. Crit Care Med. 2014;42(1):228–9. This manuscript provides a concise overview of the new nomenclature and definitions of VAC and VAEs.
33. Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol. 2014;35(5):502–10.
34. Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013;144(5):1453–60.
35. Maruna P, Nedelnikova K, Gurlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57–61.
36. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600–7.
37. Sotillo-Diaz JC, Bermejo-Lopez E, Garcia-Olivares P, Peral-Gutierrez JA, Sancho-Gonzalez M, Guerrero-Sanz JE. Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis. Med Intensiva. 2014;38(6):337–46.
38. Pugh R, Grant C, Cooke RP, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2011;10, CD007577.
39. Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation. Crit Care Med. 2011;39(7):1792–9.
40. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.
41. Hellyer TP, Conway Morris A, McAuley DF, Walsh TS, Anderson NH, Singh S, et al. Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax. 2015:70(1):41–7.
42. Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004;350(5):451–8.
43. Palazzo SJ, Simpson TA, Simmons JM, Schnapp LM. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia. Respir Care. 2012;57(12):2052–8.
44. Grover V, Pantelidis P, Soni N, Takata M, Shah PL, Wells AU, et al. A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study. PLoS ONE. 2014;9(10), e109686.
45. Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50(7):924–9. discussion 929-931.
46. Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2013;12, CD004127. This Cochrane Review demonstrates that NIPPV can facilitate earlier extubation and as such this is associated with decreased VAP rates and decreased mortality.
47. Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME. Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. J Crit Care. 2009;24(4):515–22.
48. Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD009066.
49. Rello J, Kollef M, Diaz E, Sandiumenge A, del Castillo Y, Corbella X, et al. Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med. 2006;34(11):2766–72.
50. Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300(7):805–13.
51. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2011;39(8):1985–91.
52. Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015;43(1):22–30. The main finding of this study is that subglottic secretion suctioning reduces VAP rates and decreases antibiotic use, although it did not have effect of VAC rates.
53. Nseir S. Endotracheal cuff pressure monitoring: another alarm in the ICU? Am J Crit Care. 2011;20(6):422–3. author reply 423-424.
54. Lorente L, Lecuona M, Jimenez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care. 2014;18(2):R77.
55. Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med. 2007;35(6):1543–9.
56. Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8, CD008367.
57. Munro CL, Grap MJ, Sessler CN, Elswick RK Jr., Mangar D, Karlnoski-Everall R, et al. Pre-intubation application of oral chlorhexidine does not provide additional benefit in prevention of early onset ventilator-associated pneumonia. Chest. 2015;147(2):328–34.
58. Wilke M, Grube R. Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy. Infect Drug Resist. 2013;7:1–7.
59. Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J Crit Care. 2008;23(1):91–100.
60. Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54(5):621–9.
61. Wunderink RG, Mendelson MH, Somero MS, Fabian TC, May AK, Bhattacharyya H, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus. Chest. 2008;134(6):1200–7.
62. Chan JD, Pham TN, Wong J, Hessel M, Cuschieri J, Neff M, et al. Clinical outcomes of linezolid vs vancomycin in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia: retrospective analysis. J Intensive Care Med. 2011;26(6):385–91.
63. Gonzalez RP, Rostas J, Simmons JD, Allen J, Frotan MA, Brevard SB. Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus in a trauma population. Am J Surg. 2013;205(3):255–8. discussion 258.
64. Peyrani P, Wiemken TL, Kelley R, Zervos MJ, Kett DH, File Jr TM, et al. Higher clinical success in patients with ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus treated with linezolid compared with vancomycin: results from the IMPACT-HAP study. Crit Care. 2014;18(3):R118.
65. Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 2010;38(9):1802–8. In a large metaanalysis of RCTs these authors demonstrate that there is no significant difference in linezolid compared to vancomycin for the treatment of MRSA VAP.
66. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588–98.
67. Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK. Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest. 2013;144(6):1759–67. This metaanalysis demonstrated that shorter durations of antibiotic treatment for VAP are not associated with worse outcomes as compared to longer durations of antibiotic therapy.
68. Garnacho-Montero J, Corcia-Palomo Y, Amaya-Villar R, Martin-Villen L. How to treat VAP due to MDR pathogens in ICU patients. BMC Infect Dis. 2014;14:135.