De. Craven et Ka. Steger, VENTILATOR-ASSOCIATED BACTERIAL PNEUMONIA - CHALLENGES IN DIAGNOSIS, TREATMENT, AND PREVENTION, New horizons, 6(2), 1998, pp. 30-45
Ventilator-associated pneumonia (VAP) is a common infection in intensi
ve care unit patients that results in high mortality and morbidity and
increased duration of hospital stay. Clinical diagnostic methods are
sensitive, but lack specificity. Quantitative analysis of specimens fr
om the lower respiratory tract increases specificity. Bacteria causing
VAP may originate from the patient's endogenous flora, other patients
or hospital personnel, or from environmental sources. Aspiration or d
irect inoculation are the major routes of bacterial entry into the low
er respiratory tract. The bacterial inoculum and host response in the
lung are important factors for pathogenesis. Late-onset nosocomial pne
umonia is often caused by Pseudomonas aeruginosa, Acinetobacter specie
s, and Staphylococcus aureus. Streptococcus pneumoniae and Haemophilus
influenzae, however, are the more common pathogens in early-onset dis
ease. Oropharyngeal and gastric colonization with bacteria, cross-infe
ction, as well as the indiscriminate use of antibiotics or invasive de
vices substantially increase the risk of VAP. An understanding of the
epidemiology and pathogenesis of VAP, along with implementation of app
ropriate preventive measures, are needed to decrease the incidence, mo
rbidity, and mortality associated with VAP.