Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Pneumology, Hospital Clinic, Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES).
Curr Opin Infect Dis. 2020 Apr;33(2):182-188. doi: 10.1097/QCO.0000000000000640.
Ventilator-associated pneumonia (VAP) is a serious event in critically ill patients. We aim to review the most recent evidences about VAP, including its cause, the main differences between the American and European guidelines in the definition of risk factors for multidrug-resistant pathogens, the main principles guiding empirical antibiotic treatment, and the potential role of molecular diagnostic tests.
The 2016 ATS/IDSA and the 2017 ERS/ESICM/ESCMID/ALAT guidelines provide different approaches for the management of VAP. Both guidelines highlight the need to use local epidemiological data for antibiotic choice; however, they identify different risk factors that can assist with decision making when local data are not available. Nevertheless, validation studies of the American guidelines suggest that empiric antibiotic therapy based on risk factors may lead to an overuse of broad-spectrum antibiotics. Rapid diagnostic tests may allow a faster identification of VAP cause, resulting in more adequate antimicrobial therapy and reduced exposition to broad-spectrum antibiotics.
Clinical studies should be conducted to evaluate the benefits of implementing guidelines and new approaches such as combinations of clinical data with rapid diagnostic tests; meantime adaptations of guidelines to local settings should be carried out by a local multidisciplinary expert team.
呼吸机相关性肺炎（VAP）是危重症患者的严重并发症。本综述旨在讨论 VAP 的最新研究进展，包括其发病原因，美国和欧洲指南在多重耐药病原体危险因素定义方面的主要差异，指导经验性抗生素治疗的主要原则，以及分子诊断检测的潜在作用。
2016 年 ATS/IDSA 和 2017 年 ERS/ESICM/ESCMID/ALAT 指南为 VAP 的管理提供了不同的方法。这两个指南都强调需要根据当地的流行病学数据来选择抗生素；然而，当没有当地数据时，它们确定了不同的危险因素，有助于指导决策。尽管如此，对美国指南的验证研究表明，基于危险因素的经验性抗生素治疗可能导致广谱抗生素的过度使用。快速诊断检测可更快地确定 VAP 的病因，从而使抗菌治疗更合理，并减少广谱抗生素的暴露。
应开展临床研究，评估实施指南和新方法（如将临床数据与快速诊断检测相结合）的益处；同时，应由当地多学科专家团队对指南进行适应当地情况的调整。
