Current Issues in Ventilator-Associated Pneumonia

Infections in critically ill patients account for a major proportion of the mortality, morbidity, and cost associated with their care. Infection rate in critically ill patients are about 40% and may be 50–60% in those remaining in the intensive care unit (ICU) for more then 5 days.(1,2) Pneumonia acquired in the ICU (after 48 h intuba tion) ranges from 10% to 65%,(3,4) and respiratory infections account for 30–60% of all infections acquired in the ICU(.5,6) Mortality rates of ventilator-associated pneumonia (VAP) have been very high (30–70%) and may account for 15% of all deaths in the ICU. (7–9) When controlled for severity of underlying disease and other factors the attributable mortality of VAP range from 0% to 50% absolute increase, and prolonged length of ICU stay (range 5–13 days).(10) In a recent review of the clinical and economic consequences of VAP from analysis of studies published after 1990, the findings were: 10–20% of ICU-ventilated patients will develop VAP, and are twice as likely to die compared to patients without VAP, with 6 extra days in the ICU and an additional US$10019 hospital cost per case.(11) Empiric broad-spectrum antimicrobials in the ICU for presumed pneumonia has contributed substantially to the worldwide increase in antibiotic-resistant bacteria in hospitals. This has compounded the problem of increasing morbidity, mortality, and cost because of the challenge posed by these difficult-to-treat microorganisms, particularly the use of expensive drugs and need for isolation.