Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control.

摘要

Any delay in adequate antibiotic treatment may compromise the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. Jung et al. [1] assessed the potential impact of using results of once-a-week routine quantitative endotracheal aspirate (EA) cultures to guide initial antibiotic treatment in a study of 113 episodes of bronchoalveolar lavage-confirmed VAP. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate, confirming that routine surveillance cultures may help to improve the adequacy of empiric antibiotic therapy for VAP.