Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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Among various risk factors for death among critically ill patients with serious infection, inappropriate antimicrobial therapy is an important factor that clinicians can modify directly. The presence of multidrug-resistant bacteria is the primary reason that patients with ventilator-associated pneumonia receive inappropriate antimicrobial therapy. Empirical antimicrobial therapy for ventilator-associated pneumonia should be initiated promptly and should have a broad spectrum that covers all potential antimicrobial-resistant pathogens. ⋯ Broad-spectrum therapy should be streamlined (i.e., de-escalated), as appropriate, on the basis of microbiological data and clinical response. Switching to narrower-spectrum therapy that is directed by culture results may minimize the emergence of resistance. For some patients, clinical response will allow a shortening of the duration of antimicrobial therapy.