Appropriate empiric antimicrobial therapy of nosocomial pneumonia: the role of the carbapenems.

Nosocomial pneumonia is the leading cause of death in patients with hospital-acquired infections. The development of nosocomial pneumonia prolongs hospitalization, which may cause additional days in the intensive care unit, thereby increasing overall health care costs. Empiric treatment of nosocomial pneumonia with therapies that are subsequently shown to be inappropriate therapy (defined as antimicrobial therapy that does not cover the infecting pathogens) has a detrimental effect on patient survival and can increase morbidity, length of hospital stay, and mortality. Delayed therapy can also have similar consequences. Therefore, it is necessary to begin treatment with the most appropriate regimen as soon as possible. This review considers the early use of appropriate, broad-spectrum empiric antimicrobial therapy for treating patients with nosocomial pneumonia and describes where and when the carbapenems are particularly useful. The carbapenems are active against both Gram-positive and Gram-negative pathogens, including anaerobes; resistance to carbapenems remains rare.