Optimal duration of antimicrobial therapy in ventilator-associated pneumonia: What is the role for procalcitonin?

Marilia Rita Pinzone, Bruno Cacopardo, Lilian Abbo, Giuseppe Nunnari

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Hospital-acquired pneumonia (HAP) is the major cause of hospital-acquired infections in critically ill patients. Up to 90% of intensive care unit episodes of HAP occur in mechanically ventilated patients, who may develop what is termed ventilator-associated pneumonia (VAP). An appropriate duration of antimicrobial therapy is crucial in the management of HAP: on the one hand, delay in administration of proper therapy has been associated with an increased risk of treatment failure and mortality; on the other hand, unnecessary prolongation of antimicrobial treatment may favour the emergence of multidrug-resistant bacteria and increase healthcare costs. In this review, we discuss the evidence and recommendations from international guidelines for the management of VAP and focus on randomised controlled trials comparing the clinical efficacy of a short-course vs. an extended-course antimicrobial regimen for the treatment of VAP in adults. In these trials, short-course regimens were as effective and safe as long-course regimens for the treatment of VAP, provided that infection was not due to difficult-to-treat micro-organisms such as non-fermenting Gram-negative bacilli. In addition, strategies incorporating individualised stop-points for antibiotics, i.e. clinical features or biomarkers such as procalcitonin, were shown to reduce antibiotic exposure, healthcare costs and the risk of developing antimicrobial resistance, without negatively affecting other outcomes.

Original languageEnglish
Pages (from-to)239-244
Number of pages6
JournalJournal of Global Antimicrobial Resistance
Volume2
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Ventilator-Associated Pneumonia
Calcitonin
Pneumonia
Health Care Costs
Anti-Bacterial Agents
Therapeutics
Cross Infection
Treatment Failure
Critical Illness
Bacillus
Intensive Care Units
Randomized Controlled Trials
Biomarkers
Guidelines
Bacteria
Mortality
Infection

Keywords

  • Antimicrobial stewardship
  • Duration of antimicrobial therapy
  • Guidelines
  • VAP
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Immunology
  • Microbiology
  • Immunology and Allergy
  • Microbiology (medical)

Cite this

Optimal duration of antimicrobial therapy in ventilator-associated pneumonia : What is the role for procalcitonin? / Pinzone, Marilia Rita; Cacopardo, Bruno; Abbo, Lilian; Nunnari, Giuseppe.

In: Journal of Global Antimicrobial Resistance, Vol. 2, No. 4, 01.01.2014, p. 239-244.

Research output: Contribution to journalArticle

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