Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT 06030-1321, USA.
Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
Clin Chest Med. 2018 Dec;39(4):797-808. doi: 10.1016/j.ccm.2018.08.002.
Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniques with quantitative cultures to determine the cause of VAP; the other recommends either invasive or noninvasive techniques. Both guidelines recommend short-course therapy be used for most patients with VAP. Although neither guideline recommends use of procalcitonin as an adjunct to clinical judgment when diagnosing VAP, they differ with respect to use of serial procalcitonin to shorten the length of antibiotic treatment.
两份近期关于呼吸机相关性肺炎（VAP）诊断和治疗的主要指南建议，在制定初始经验性抗生素治疗方案时，应考虑当地抗生素耐药模式和耐药病原体的个体患者风险。一份指南建议避免使用定量培养的有创诊断技术来确定 VAP 的病因；另一份则建议使用有创或无创技术。两份指南都建议大多数 VAP 患者采用短程治疗。虽然两份指南都不建议将降钙素原作为诊断 VAP 时临床判断的辅助手段，但在使用降钙素原来缩短抗生素治疗时间方面存在差异。
