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Current Issues in Ventilator-Associated Pneumonia

Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)

Infections in critically ill patients account for a major proportion of the mortality, morbidity, and cost associated with their care. Infection rate in critically ill patients are about 40% and may be 50–60% in those remaining in the intensive care unit (ICU) for more then 5 days.1,2 Pneumonia acquired in the ICU (after 48 h intuba tion) ranges from 10% to 65%,3,4 and respiratory infections account for 30–60% of all infections acquired in the ICU.5,6 Mortality rates of ventilator-associated pneumonia (VAP) have been very high (30–70%) and may account for 15% of all deaths in the ICU. 7–9 When controlled for severity of underlying disease and other factors the attributable mortality of VAP range from 0% to 50% absolute increase, and prolonged length of ICU stay (range 5–13 days).10 In a recent review of the clinical and economic consequences of VAP from analysis of studies published after 1990, the findings were: 10–20% of ICU-ventilated patients will develop VAP, and are twice as likely to die compared to patients without VAP, with 6 extra days in the ICU and an additional US$10019 hospital cost per case.11

Empiric broad-spectrum antimicrobials in the ICU for presumed pneumonia has contributed substantially to the worldwide increase in antibiotic-resistant bacteria in hospitals. This has compounded the problem of increasing morbidity, mortality, and cost because of the challenge posed by these difficult-to-treat microorganisms, particularly the use of expensive drugs and need for isolation.

Keywords

Intensive Care Unit Patient Nosocomial Pneumonia Noninvasive Positive Pressure Ventilation Quantitative Culture Stress Ulcer Prophylaxis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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