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Updated: May 13, 2025

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia

Published on: June 28, 2018

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The pathogenesis of ventilator-associated pneumonia: old and new mechanisms

Arnau Ulsamer1,2, Sergio Bonilla3, Xosé Pérez-Fernández1,2

  • 1Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.

Expert Review of Respiratory Medicine
|April 14, 2025
PubMed
Abstract

Insights

Ventilator-associated pneumonia (VAP) is a common intensive care unit infection. Recent research highlights how disruption of the lung microbiome (dysbiosis) significantly impacts VAP development and host immunity.

Area of Science:

  • Microbiology
  • Immunology
  • Critical Care Medicine

Background:

  • Ventilator-associated pneumonia (VAP) is a frequent nosocomial infection in ICUs, increasing patient morbidity, mortality, and healthcare costs.
  • Traditionally, the lower respiratory tract was considered sterile, but new diagnostics reveal a complex microbial ecosystem.
  • Dysbiosis, or disruption of this ecosystem, is now recognized as a critical factor in VAP pathogenesis.

Purpose of the Study:

  • To review classical and emerging mechanisms of VAP development.
  • To explore the role of the lung microbiome and dysbiosis in VAP.
  • To discuss the significance of microbiome-immunity interactions in VAP pathophysiology.

Main Methods:

  • Literature review of VAP pathogenesis.
  • Analysis of recent findings on lung microbiome dynamics.
  • Examination of host immunity regulation by the microbiome.

Main Results:

  • Dysbiosis is a key factor in VAP development, challenging the sterile lung paradigm.
  • Host immunity is regulated by the microbiome and is profoundly affected by dysbiosis.
  • Microbiome-immunity crosstalk plays a significant role in VAP pathophysiology.

Conclusions:

  • Understanding VAP pathogenesis requires acknowledging the lung microbiome.
  • Dysbiosis and its impact on host immunity are central to VAP.
  • Further research into microbiome-immunity interactions can lead to improved VAP prevention and treatment strategies.
Keywords:
Nosocomial infectiondysbiosisimmunoparalysisimmunosuppressionmechanical ventilationmicrobiotatranscolonizationventilator associated pneumonia

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