Department of Medical Microbiology, Julius Center for Public Health and Primary Care, University Medical Center Utrecht, Heidelberglaan, the Netherlands.
Clin Infect Dis. 2011 Jan 1;52(1):115-21. doi: 10.1093/cid/ciq075.
Ventilator-associate pneumonia (VAP) is the most common nosocomial infection in patients in intensive care units (ICU). Because of its association with unwanted clinical outcomes, preventive measures have been studied intensively in the past 25 years. Unfortunately, a large amount of clinical trials yielded disappointingly few clear-cut answers. Furthermore, because of the difficulties in reliably diagnosing VAP, we should be very reluctant in embracing measures that have been associated with VAP reductions in small-sized studies, but with no benefits on patient outcome documented in sufficiently powered well-designed trials. Only topical antimicrobial prophylaxis (either alone in the oropharynx or in combination with intestinal decontamination) has been demonstrated to improve patient outcome resulting from prevention of VAP. However, this was demonstrated in not-so-average circumstances-in ICUs with extremely low levels of antibiotic resistance. Despite the obvious challenges with using antibiotics as preventive measures, careful evaluation of these strategies in settings with higher drug-resistance levels is now justified, and future studies should be designed to demonstrate outcome benefits rather than reductions in VAP rates.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）患者中最常见的医院获得性感染。由于其与不良临床结局相关，过去 25 年来，人们一直在深入研究预防措施。不幸的是，大量临床试验得出的结果令人失望，几乎没有明确的答案。此外，由于 VAP 的诊断存在困难，我们应该非常不愿意接受那些在小规模研究中与 VAP 减少相关但在足够强大的设计良好的试验中没有记录到对患者结局有益的措施。只有局部抗菌预防（单独在口咽部或与肠道去污联合使用）已被证明可改善因预防 VAP 而导致的患者结局。然而，这是在抗生素耐药率极低的 ICU 中，在非一般情况下证明的。尽管将抗生素用作预防措施存在明显的挑战，但现在有理由在耐药水平较高的环境中仔细评估这些策略，未来的研究应旨在证明结局获益，而不是降低 VAP 发生率。
