Nosocomial pneumonia and pneumonia associated with mechanical ventilation

Mortality attributable to ventilator-associated pneumonia (VAP) is about 10%, and within the new classification of lower respiratory tract infections (LRTI), patients diagnosed with VHAP had the highest in-hospital mortality. Pathogenesis is multifactorial, with gram-negative bacteria responsible for the majority of bacterial cases of HAP/VAP (more than 60%). Physical examination findings (fever, purulent secretions), chest radiograph, endotracheal aspirate cultures, bronchoscopic cultures, and clinical lung infection index (CPIS) have poor accuracy for diagnosing VAP. Recent guidelines do not recommend the use of biomarkers for the diagnosis of VAP, although they suggest that they may offer guidance on the duration of treatment. We look forward to further studies in Stewardship programs with the new molecular tools for the use of antibiotics in VAP. We present the recommendations for empirical antimicrobial treatment of ERS/ESICM/ESCMID/ALAT, with the new antibiotics and recommendations for the prevention of VAP. Updates to the guidelines of both the American and European guidelines are necessary.