Ventilator-associated pneumonia: Current management strategies

Ventilator-associated pneumonia is a dynamic disease caused by a wide spectrums of pathogens and associated with high morbidity and mortality. Diagnosis is often made on the basis of clinical criteria and assessment of endotracheal aspirates. The use of quantitative endotracheal aspirates or bronchoalveolar lavage with or without protected specimen brush improves diagnostic specificity, may reduce antibiotic consumption, and may be associated with better outcomes. Choice of initial antibiotic therapy is often empiric, based on disease severity, patient risk factors, and the potential for infection with multidrug-resistant bacterial pathogens. Based on clinical, response and microbiologic results, antibiotics can be streamlined, or discontinued if pneumonia is not present. Targeted prevention strategies are essential to reduce short- and long-term risks of pneumonia.