Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management
Abstract
PURPOSE OF REVIEW: The recent evidence is reviewed on clinical epidemiology, trends in bacterial resistance, diagnostic tools and therapeutic options in hospital-acquired pneumonia (HAP), with a special focus on ventilator-associated pneumonia (VAP). RECENT FINDINGS: The current incidence of VAP ranges from two to 16 episodes for 1000 ventilator-days, with an attributable mortality of 3-17%. Staphylococcus aureus (with 50-80% of methicillin-resistant strains), Pseudomonas aeruginosa and Enterobacteriaceae represent the most frequent pathogens in HAP/VAP. The prevalence of carbapenemase-producing Gram-negative bacilli (GNB) and the emergence of colistin resistance are alarming. Procalcitonin seems to have a good value to monitor the response to treatment. Rapid molecular tests for the optimization of empirical therapy will be available soon. Recent studies support the use of a high-dosing regimen of colistin in HAP/VAP caused by extensively drug-resistant GNB. Linezolid may probably be preferred to vancomycin for a subset of methicillin-resistant S. aureus HAP/VAP. Given the scarcity of novel antimicrobial drugs, different approaches such as bacteriophage therapy or immunotherapy warrant further clinical evaluations. SUMMARY: HAP/VAP is a major cause of deaths, morbidity and resources utilization, notably in patients with severe underlying conditions. The development of new diagnostic tools and therapeutic weapons is urgently needed to face the epidemic of multidrug-resistant pathogens.
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Ventilator-associated pneumonia (VAP) frequently occurs in patients requiring mechanical ventilation, leading to high mortality, with an incidence from 5% to 67% depending on the population studied and the diagnostic criteria used.
“Ventilator-associated pneumonia (VAP) frequently occurs in patients requiring mechanical ventilation, leading to high mortality, with an incidence from 5% to 67% depending on the population studied and the diagnostic criteria used (Barbier et al., 2013; Torres et al., 2017).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Barbier et al., 2013
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Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection
Bao, L., Zhang, C., Dong, J., Zhao, L., Li, Y., & Sun, J. (2020) · Frontiers in Microbiology · doi:10.3389/fmicb.2020.01840 · Cited by 207 · see citing works
- Authors
- Barbier, F., Andremont, A., Wolff, M., & Bouadma, L.
- Affiliations
- Centre hospitalier universitaire d'Orléans (FR)
- Sorbonne Paris Cité (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Bouadma, Lila
- Venue
- Current Opinion in Pulmonary Medicine
- Published
- 2013-05
- Volume
- 19
- Issue
- 3
- Pages
- 216-228
- ISSN
- 1070-5287 (ISSN-L)
- OpenAlex
- W2023057700
- Cited by
- 281
- References
- 151
- Citations by year
- 2026: 7 · 2025: 20 · 2024: 15 · 2023: 21 · 2022: 20 · 2021: 32 · 2020: 32 · 2019: 20 · 2018: 20 · 2017: 23 · 2016: 21 · 2015: 25 · 2014: 20 · 2013: 5
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Pulmonary Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Astellas Pharma
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- nosocomial pneumonia, ventilator-associated pneumonia, antimicrobial resistance, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacteriaceae, colistin resistance, procalcitonin, rapid molecular diagnostics, empirical antibiotic therapy, linezolid, vancomycin, phage therapy, immunotherapy, multidrug-resistant pathogens
- MeSH terms
- Anti-Bacterial Agents, Cross Infection, Humans, Intensive Care Units, Pneumonia, Staphylococcal Infections, Incidence, Prevalence, Cost of Illness, Drug Resistance, Multiple, Bacterial, Pneumonia, Ventilator-Associated, Methicillin-Resistant Staphylococcus aureus
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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