Current opinion in pulmonary medicine
-
Ventilator-associated pneumonia (VAP) is the most serious and controversial of the infections of the critically ill patient. The accuracy of standard methods of diagnosis remains under constant scrutiny, and at the same time there is increasing debate about whether it is a preventable disease. This review focuses on the pathophysiology of respiratory tract infection in the ventilated patient, and how the latest advances have grown from our current understanding of its pathogenesis. ⋯ This review will focus on: the current understanding of the pathogenesis of VAT and VAP, modifiable risk factors and new approaches to treatment, and bacterial resistance challenges.
-
The review highlights the clinical findings and the management of community-acquired, health-care associated and nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). ⋯ Rapid recognition of possible staphylococcal infection in patients with severe pneumonia is essential. The treatment of MRSA pneumonia must be prompt and effective in order to allow a fast microbiological clearance and to successfully manage the infection.
-
The relevance of antibiotics in the treatment of acute exacerbation has been a matter of debate for several years. Although expert recommendations may vary, there is general agreement about the fact that not all patients will equally experience benefit from antibiotics: apart from decreasing costs, discriminate use of antibiotics is capable of significantly reducing subsequent colonization or infection with antibiotic-resistant bacteria. ⋯ Most of the proposed criteria for prescribing or withholding antibiotics for acute exacerbation have been analyzed in different retrospective study designs. Patients requiring ICU care and mechanical ventilation for chronic obstructive pulmonary disease exacerbation should receive antibiotics. Conversely, antibiotics can be withheld in patients admitted to the emergency department with low serum procalcitonin levels. Patients with type I Anthonisen exacerbation and those with severe functional impairment are likely to benefit from antibiotics. Further investigations are needed to compare long-term outcome in patients treated according to clinical and functional criteria.