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Updated: Aug 11, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Incidence of antimicrobial-resistant ventilator associated pneumonia: an eighteen-month survey
O Piazza1, A Iasiello, C PapaIanni
1Intensive Care Unit, Federico II University, Naples, Italy. orpiazza@unina.it
Aim:
Microbes commonly involved in ventilator associated pneumonia (VAP) are difficult to eradicate: Pseudomonas aeruginosa and Acinetobacter baumannii are often resistant to piperacillin, aztreonam and ceftazidim while Klebsiella pneumoniae and other Enterobacteriaceae are resistant to third generation cephalosporins. Physicians need to tailor their therapeutic approach depending on individual patients and clinical setting, firmly based on local epidemiology. The aim of this study was to assess the incidence of VAP caused by multidrug-resistant bacteria in our ICU.
Methods:
We conducted a retrospective review of all patients mechanically ventilated for longer than 72 h, who developed pneumonia over an eighteen-month period for whom final culture data were available. One-hundred and forty-three patients admitted to a University Hospital medical surgical ICU were included in this survey. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by mini- bronchoalveolar lavage.
Results:
In this study, the incidence of VAP in the period January 1, 2002-June 31, 2003 was very high, accounting for about 20% of all at-risk cases. Multiresistant agents were involved in about 57% of VAP occurring within 7 days of mechanical ventilation, and in 80% of late VAP.
Conclusions:
This study revealed differences in VAP incidence and features among our ICU and literature data, indicating a need for caution when using hospital infection surveillance data for comparisons and choice of therapy. In our setting, with high levels of antibiotic resistance, combined approaches of non-antibiotic using strategies and education programs might be beneficial.
Insights
Ventilator-associated pneumonia (VAP) incidence was high, with multidrug-resistant bacteria causing over half of early cases and 80% of late cases. This highlights the need for tailored VAP treatment strategies based on local resistance patterns.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) poses a significant challenge due to the prevalence of multidrug-resistant (MDR) bacteria.
- Common VAP pathogens like Pseudomonas aeruginosa and Acinetobacter baumannii exhibit resistance to standard antibiotics, while Klebsiella pneumoniae and other Enterobacteriaceae are resistant to third-generation cephalosporins.
- Effective VAP management necessitates therapeutic approaches tailored to individual patient factors and local epidemiological data.
Purpose of the Study:
- To determine the incidence of VAP caused by multidrug-resistant bacteria in a university hospital's medical-surgical intensive care unit (ICU).
Main Methods:
- A retrospective review was conducted on 143 patients who were mechanically ventilated for over 72 hours and developed VAP.
- VAP diagnosis adhered to Centers for Disease Control and Prevention (CDC) criteria and was confirmed by mini-bronchoalveolar lavage.
- Data were collected over an eighteen-month period, with final culture results available for analysis.
Main Results:
- The study identified a high incidence of VAP, affecting approximately 20% of at-risk patients during the study period (January 1, 2002 - June 30, 2003).
- Multidrug-resistant agents were implicated in 57% of VAP cases occurring within 7 days of mechanical ventilation.
- Late-onset VAP (after 7 days) showed an even higher involvement of multidrug-resistant agents, at 80%.
Conclusions:
- The findings indicate significant differences in VAP incidence and characteristics compared to existing literature, underscoring the need for caution in comparing hospital infection surveillance data.
- High levels of antibiotic resistance in the studied ICU necessitate careful consideration of therapeutic choices.
- Combined strategies, including non-antibiotic interventions and educational programs, may be beneficial for managing VAP in settings with high antibiotic resistance.
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