Ventilator-associated pneumonia (VAP) is common and associated with high morbidity, mortality, and health-care costs, estimated to be $40,000/case. VAP has a cumulative incidence of 10 to 25% and accounts for approximately 25% of all ICU infections and > 50% of the antibiotics prescribed in ICU, making it a primary focus for risk-reduction strategies. Crude mortality rates for VAP may be as high as 20 to 70% and are generally highest in medical ICU patients and those with bacteremia or pneumonia due to multidrug-resistant (MDR) pathogens, such as Pseudomonas aeruginosa or Acinetobacter species, and methicillin-resistant Staphylococcus aureus (MRSA).
Due to the limitations on space and the number of citations for this review, highlights from selected guidelines and publications on VAP prevention in adults, primarily published after January 1, 2003, were included. Emphasis was placed on new concepts, controversies, and barriers to implementing beneficial, cost-effective programs aimed at reducing VAP and improving patient outcomes.
As with the general population, hospitalized patients are now older and have more comorbidities immune dysfunction, invasive procedures, and exposure to antibiotics. Patients are also increasingly mobile and more likely to reside in short-term and long-term health-care settings, increasing the risk of colonization, person-to-person transmission, and infection with MDR pathogens. MDR Gram-negative bacilli, such as P aeruginosa, Klebsiella pneumoniae, and Acinetobacter species, often result into higher patient mortality, longer hospital stays, poorer functional status at discharge, and need for transitional care”
MRSA now accounts for > 50% of the ICU-acquired staphylococcal infections in the United States, is associated with significant mortality and morbidity, and is a challenge for infection control teams. The rapid emergence of community-acquired MRSA infection and its increasing role in hospitals is of great concern, as these isolates are genetically distinct from hospital strains, and often carry the Pantin-Valentine leukocidin virulence factor, which presents greater clinical and infection control challenges.