Antibiotic therapy of ventilator-associated pneumonia - a reappraisal of rationale in the era of bacterial resistance

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infec tion in intensive care units (ICU). Resistance patterns seen in ICUs sugges t that prescribing recommendations should be reappraised to limit practices engendering resistance to large families of antibiotics. Despite concern s urrounding the use of antibiotics in the management of VAP, there is limite d evidence to assist the clinician in making decisions about the indication s for such therapy, the selection of the correct antibiotic(s), the timing of initiation of therapy and its duration. The high amount of antibiotic us e, in combination with the low grade colonisation of patients with multi-re sistant pathogens at the time of admission, turns the ICU into an environme nt where antibiotic policy is likely to have an effect on the resistance pr oblem. Opinions are changing as to the validity of invasive techniques in g uiding prescribing decisions. Invasive and semi-invasive diagnostic testing increases physician confidence in the diagnosis and management of VAP and helps to limit or discontinue antibiotic treatment. (C) 2001 Elsevier Scien ce B.V. and International Society of Chemotherapy. All rights reserved.