The second most important infectious complication in hospitalised patients is pneumonia, and it hits first place in the Intensive Care Unit (ICU). Almost 80% of the episodes of health-care pneumonia happens when patient is under mechanical ventilation, causing ventilator-associated pneumonia (VAP). VAP is associated with the highest rates of mortality in ICU infections, mainly if due to Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). It also increases days under mechanical ventilation and the length of stay in ICU and hospital. Although all the diagnostic procedures, the diagnosis of VAP is based basically in the clinics: X-ray infiltrates and purulent endotracheal secretions are the cornerstone of the diagnosis. We should evaluate and screen any risk factor for multiresistant pathogens. If we have an early VAP and no risk factors, the majority of empiric antibiotic strategies are useful, but if we have a patient with more than one week under mechanical ventilation, previous antibiotic use, and risk factors for multiresistant pathogens, we should then individualize empiric antibiotic treatment.

译文

住院患者中第二重要的感染并发症是肺炎,在重症监护病房 (ICU) 中排名第一。当患者处于机械通气状态时,几乎80% 的医疗保健肺炎发作发生,导致呼吸机相关性肺炎 (VAP)。VAP与ICU感染的死亡率最高,主要是由于铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌 (MRSA) 引起的。它还会增加机械通气下的天数以及在ICU和医院的住院时间。尽管所有诊断程序,但VAP的诊断基本上基于临床: x射线浸润和化脓性气管内分泌物是诊断的基石。我们应该评估和筛选多重耐药病原体的任何危险因素。如果我们有早期VAP并且没有危险因素,则大多数经验性抗生素策略是有用的,但是如果我们有一个患者在机械通气下超过一周,以前使用过抗生素以及多重耐药病原体的危险因素,则我们应该个体化经验性抗生素治疗。

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