Donald E Craven1, Jana Hudcova, Jawad Rashid. 1. aCenter for Infectious Diseases Research & Prevention bDepartment of Surgical Critical Care, Lahey Hospital & Medical Center, Burlington cTufts University School of Medicine dTufts School of Medicine Public Health Program, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: The present review draws our attention to ventilator-associated tracheobronchitis (VAT) as a distinct clinical entity that has been associated with progression to ventilator-associated pneumonia (VAP) and worse patient outcomes. In contrast to VAP, which has been extensively investigated for over the past 30 years, most VAT studies have been conducted in the past decade. There are ample data which demonstrate that VAT may progress to VAP, have more ventilator days, and have longer ICU stay that may translate into higher healthcare costs. RECENT FINDINGS: The article focuses on the diagnostic criteria for VAT, causative agents, and studies analyzing associations between VAT and patient outcomes in relation to early, appropriate intravenous, and/or aerosolized antibiotic therapy. Aerosolized antibiotic treatment delivered by improved device technology is a novel approach that has proved to be effective for the treatment and eradication of multidrug-resistant bacterial pathogens. Aerosolized antibiotics are effective in decreasing the use of systemic antibiotics, reducing bacterial resistance, and may also facilitate clinical resolution of infection. SUMMARY: Evidence presented in this review supports treatment of VAT with early and appropriate antibiotic therapy as a standard of care to reduce VAP, ventilator days, and duration of ICU stay in high-risk patient population.
PURPOSE OF REVIEW: The present review draws our attention to ventilator-associated tracheobronchitis (VAT) as a distinct clinical entity that has been associated with progression to ventilator-associated pneumonia (VAP) and worse patient outcomes. In contrast to VAP, which has been extensively investigated for over the past 30 years, most VAT studies have been conducted in the past decade. There are ample data which demonstrate that VAT may progress to VAP, have more ventilator days, and have longer ICU stay that may translate into higher healthcare costs. RECENT FINDINGS: The article focuses on the diagnostic criteria for VAT, causative agents, and studies analyzing associations between VAT and patient outcomes in relation to early, appropriate intravenous, and/or aerosolized antibiotic therapy. Aerosolized antibiotic treatment delivered by improved device technology is a novel approach that has proved to be effective for the treatment and eradication of multidrug-resistant bacterial pathogens. Aerosolized antibiotics are effective in decreasing the use of systemic antibiotics, reducing bacterial resistance, and may also facilitate clinical resolution of infection. SUMMARY: Evidence presented in this review supports treatment of VAT with early and appropriate antibiotic therapy as a standard of care to reduce VAP, ventilator days, and duration of ICU stay in high-risk patient population.
Authors: Leonilda Giani Pontes; Fernando Gatti de Menezes; Priscila Gonçalves; Alexandra do Rosário Toniolo; Claudia Vallone Silva; Julia Yaeko Kawagoe; Camila Marques Dos Santos; Helena Maria Fernandes Castagna; Marinês Dalla Valle Martino; Luci Corrêa Journal: Einstein (Sao Paulo) Date: 2017
Authors: Katarina Rejlekova; Katarina Kalavska; Marek Makovnik; Nikola Hapakova; Michal Chovanec; Valentina De Angelis; Jana Obertova; Patrik Palacka; Zuzana Sycova-Mila; Jozef Mardiak; Michal Mego Journal: Front Oncol Date: 2022-06-17 Impact factor: 5.738