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How to treat VAP due to MDR pathogens in ICU patients
José Garnacho-Montero1, Yael Corcia-Palomo, Rosario Amaya-Villar
1Unidad Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España. jgarnachom@gmail.com.
Background:
The increasing occurrence of multidrug resistant (MDR) bacteria arises at a time when there is a lack of antibiotics active against these pathogens and few new antimicrobials are in the pipelines of the pharmaceutical industry. Treatment of ventilator-associated pneumonia (VAP) caused especially by MDR Gram-negative bacilli (GNB) represents a real challenge due to the dearth of treatment options.
Methods:
We searched the medical literature relevant about management of ventilator-associated pneumonia caused by multi-drug resistant pathogens including GNB and methicillin-resistant S. aureus.
Results:
Empirical therapy should be prescribed based on the local pattern of susceptibilities. Colistin and tigecycline are in many cases the unique options for the treatment of many episodes of VAP caused by MDR-GNB. Tigecyline (not licensed for treatment of pneumonia) should be used with an initial bolus of 200 mg followed by 100 mg every 12 h. The need for a loading dose and the administration of high doses of colistin (9 million IU/day in two or three doses) is currently accepted. Vancomycin has been considered the treatment of choice for pneumonia due to MRSA although linezolid may provide higher rate of clinical cure for MRSA VAP with a good safety profile. The initial antibiotic treatment must be reassessed and simplify in accordance of culture results.
Conclusions:
Empirical treatment of VAP due to MDR pathogens should be based on knowledge of local ecology. A strategy combining early high doses of effective agents with subsequent simplification in the light of microbiologic information is recommended.
Insights
Treating multidrug-resistant (MDR) pathogens in ventilator-associated pneumonia (VAP) is challenging. Empirical therapy for VAP requires knowledge of local resistance patterns and early use of effective agents, followed by simplification based on culture results.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Rising incidence of multidrug-resistant (MDR) bacteria.
- Limited new antimicrobial agents in development.
- Ventilator-associated pneumonia (VAP) caused by MDR Gram-negative bacilli (GNB) presents significant treatment challenges.
Purpose of the Study:
- To review the management of VAP caused by MDR pathogens.
- To provide guidance on empirical and targeted therapy.
Main Methods:
- Literature search on VAP management in MDR pathogens.
- Focus on GNB and methicillin-resistant Staphylococcus aureus (MRSA).
Main Results:
- Empirical therapy for VAP should be guided by local susceptibility patterns.
- Colistin and tigecycline are key options for MDR-GNB VAP, with specific dosing recommendations.
- Vancomycin is standard for MRSA VAP, while linezolid may offer better clinical cure rates.
Conclusions:
- Empirical VAP treatment for MDR pathogens necessitates understanding local resistance.
- A recommended strategy involves early high-dose effective agents, simplified by microbiologic data.
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