Risk factors for
hospital-acquired pneumonia developing in specific ICUs (neurologic and cardiovascular surgery) were reported. Characteristics of
pneumonia acquired in general wards but requiring ICU admission were studied. Analysis of the impact of reintubation on
pneumonia occurrence demonstrated that only reintubation after accidental extubation increases the risk. Early administration of adequate
antibiotic(s), associated with a deescalating strategy, remains the only measure directly amenable to modification by clinicians that decreases the
infection-related mortality. Numerous data emphasized the recommendation that guidelines for
hospital-acquired pneumonia therapy should be updated and customized to local patterns to improve the level of adequacy of antimicrobial treatment. A 8-day treatment regimen could be proposed when
pneumonia is not caused by a nonfermenting, gram-negative bacilli. In cases of
pneumonia caused by methicillin-resistant Staphylococcus aureus,
linezolid, compared with
vancomycin, significantly increases the rates of cure and survival. Semirecumbent positioning in all eligible patients,
sucralfate rather than H2 antagonists in patients at low to moderate risk of gastrointestinal
bleeding, and, in selected patients, aspiration of subglottic secretions and oscillating beds are the measures proposed to prevent the development of
ventilator-associated pneumonia. Conversely, the routine or indiscriminate use of selective digestive decontamination is not recommended.
SUMMARY: