Kenaa Blaine, Richert Mary Elizabeth, Claeys Kimberly C, Shipper Andrea, Sullivan Kaede V, Schrank Gregory M, O'Hara Lyndsay M, Morgan Daniel J, Shanholtz Carl, Leekha Surbhi
Department of Medicine, Department of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca st. Second floor pulmonary, Baltimore, MD, 21201, USA.
Division of Internal Medicine, PGY-3, Department of Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA.
Curr Infect Dis Rep. 2019 Nov 21;21(12):50. doi: 10.1007/s11908-019-0708-3.
Ventilator-associated pneumonia (VAP) is one of the most common infections in the ICU. Prompt diagnosis is vital as mortality increases with delayed antibiotic therapy. However, accurate diagnosis is challenging due to non-specific clinical features in a complicated patient cohort. Microbiological culture data remains a crucial aspect in confirming diagnosis.
Literature data comparing the benefit of invasive respiratory sampling to non-invasive is inconclusive. Differences in culturing practices translate in overidentification of organisms of unclear significance. Positive culture data in a low pre-test probability does not differentiate between true infection and colonization resulting in overtreatment. Furthermore, there are also opportunities for modifying the reporting of respiratory tract cultures that can better guide antimicrobial therapy. Under the umbrella of antimicrobial stewardship, diagnostic stewardship can be incorporated to create a systematic approach that would target culturing practices to match the right pre-test probability. Ideal outcome will be targeting cultures to the right patient population and minimizing unnecessary treatment.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中最常见的感染之一。由于延迟使用抗生素治疗会增加死亡率，因此及时诊断至关重要。然而，由于复杂患者群体的临床特征不具特异性，准确诊断具有挑战性。微生物培养数据仍然是确诊的关键方面。
比较侵入性呼吸道采样与非侵入性呼吸道采样益处的文献数据尚无定论。培养方法的差异导致对意义不明的微生物过度识别。低预测试概率下的阳性培养数据无法区分真正的感染和定植，从而导致过度治疗。此外，修改呼吸道培养报告方式也有机会更好地指导抗菌治疗。在抗菌管理的框架下，可以纳入诊断管理，以创建一种系统方法，使培养方法与正确的预测试概率相匹配。理想的结果是针对合适的患者群体进行培养，并尽量减少不必要的治疗。
