Nosocomial and Ventilator-associated Pneumonia
Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review s...
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| Vydané v: | Open respiratory archives Ročník 7; číslo 4; s. 100488 |
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| Hlavní autori: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Spain
Elsevier España, S.L.U
01.10.2025
Elsevier |
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| ISSN: | 2659-6636, 2659-6636 |
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| Abstract | Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.
La neumonía nosocomial (NN), incluyendo su subtipo la neumonía asociada a ventilación mecánica (NAVM), constituye una de las principales causas de morbilidad, mortalidad y aumento de los costes sanitarios en pacientes hospitalizados, especialmente en unidades de cuidados intensivos. Esta revisión, presentada en un formato de preguntas y respuestas, sintetiza la evidencia actual sobre la epidemiología, fisiopatología y manejo de la NN y la NAVM, con especial atención a los patógenos multirresistentes (PMR). Se analizan las diferencias clave entre la NN y la NAVM en cuanto a perfil microbiológico, estrategias diagnósticas e implicaciones terapéuticas. Se detallan los principales factores de riesgo para infecciones por PMR—como la ventilación prolongada, la exposición previa a antibióticos y la inmunosupresión—, destacando la necesidad de una estratificación individualizada del riesgo para guiar el tratamiento empírico. Se revisan críticamente las recomendaciones de las principales guías internacionales (IDSA/ATS, ERS, SEPAR), resaltando coincidencias y discrepancias, especialmente en cuanto al uso de tratamientos empíricos de amplio o estrecho espectro. Asimismo, se discute el papel de las técnicas diagnósticas moleculares rápidas, como la PCR múltiple, en la mejora del rendimiento diagnóstico y la optimización del uso de antimicrobianos. Se incluye un análisis actualizado de los nuevos antibióticos disponibles frente a PMR, contextualizado en pacientes críticos, y se revisa la evidencia que respalda pautas abreviadas de 7-8 días en pacientes con buena evolución clínica. Finalmente, se aborda la utilidad de la procalcitonina como biomarcador para orientar la suspensión del tratamiento antibiótico. |
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| AbstractList | Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.
La neumonía nosocomial (NN), incluyendo su subtipo la neumonía asociada a ventilación mecánica (NAVM), constituye una de las principales causas de morbilidad, mortalidad y aumento de los costes sanitarios en pacientes hospitalizados, especialmente en unidades de cuidados intensivos. Esta revisión, presentada en un formato de preguntas y respuestas, sintetiza la evidencia actual sobre la epidemiología, fisiopatología y manejo de la NN y la NAVM, con especial atención a los patógenos multirresistentes (PMR). Se analizan las diferencias clave entre la NN y la NAVM en cuanto a perfil microbiológico, estrategias diagnósticas e implicaciones terapéuticas. Se detallan los principales factores de riesgo para infecciones por PMR—como la ventilación prolongada, la exposición previa a antibióticos y la inmunosupresión—, destacando la necesidad de una estratificación individualizada del riesgo para guiar el tratamiento empírico. Se revisan críticamente las recomendaciones de las principales guías internacionales (IDSA/ATS, ERS, SEPAR), resaltando coincidencias y discrepancias, especialmente en cuanto al uso de tratamientos empíricos de amplio o estrecho espectro. Asimismo, se discute el papel de las técnicas diagnósticas moleculares rápidas, como la PCR múltiple, en la mejora del rendimiento diagnóstico y la optimización del uso de antimicrobianos. Se incluye un análisis actualizado de los nuevos antibióticos disponibles frente a PMR, contextualizado en pacientes críticos, y se revisa la evidencia que respalda pautas abreviadas de 7-8 días en pacientes con buena evolución clínica. Finalmente, se aborda la utilidad de la procalcitonina como biomarcador para orientar la suspensión del tratamiento antibiótico. Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs - including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression - emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL-, KPC-, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7-8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance. AbstractNosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance. Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs - including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression - emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL-, KPC-, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7-8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs - including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression - emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL-, KPC-, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7-8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance. Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance. Resumen: La neumonía nosocomial (NN), incluyendo su subtipo la neumonía asociada a ventilación mecánica (NAVM), constituye una de las principales causas de morbilidad, mortalidad y aumento de los costes sanitarios en pacientes hospitalizados, especialmente en unidades de cuidados intensivos. Esta revisión, presentada en un formato de preguntas y respuestas, sintetiza la evidencia actual sobre la epidemiología, fisiopatología y manejo de la NN y la NAVM, con especial atención a los patógenos multirresistentes (PMR). Se analizan las diferencias clave entre la NN y la NAVM en cuanto a perfil microbiológico, estrategias diagnósticas e implicaciones terapéuticas. Se detallan los principales factores de riesgo para infecciones por PMR—como la ventilación prolongada, la exposición previa a antibióticos y la inmunosupresión—, destacando la necesidad de una estratificación individualizada del riesgo para guiar el tratamiento empírico. Se revisan críticamente las recomendaciones de las principales guías internacionales (IDSA/ATS, ERS, SEPAR), resaltando coincidencias y discrepancias, especialmente en cuanto al uso de tratamientos empíricos de amplio o estrecho espectro. Asimismo, se discute el papel de las técnicas diagnósticas moleculares rápidas, como la PCR múltiple, en la mejora del rendimiento diagnóstico y la optimización del uso de antimicrobianos. Se incluye un análisis actualizado de los nuevos antibióticos disponibles frente a PMR, contextualizado en pacientes críticos, y se revisa la evidencia que respalda pautas abreviadas de 7-8 días en pacientes con buena evolución clínica. Finalmente, se aborda la utilidad de la procalcitonina como biomarcador para orientar la suspensión del tratamiento antibiótico. |
| ArticleNumber | 100488 |
| Author | Raboso Moreno, Beatriz Urrutia-Royo, Blanca González Muñoz, Imanol González Gutiérrez, Jessica Cabanillas Díez-Madroñero, Carlos Pou Álvarez, Cristina Erro Iribarren, Marta |
| Author_xml | – sequence: 1 givenname: Carlos surname: Cabanillas Díez-Madroñero fullname: Cabanillas Díez-Madroñero, Carlos organization: Pulmonology Department, Dr. Josep Trueta University Hospital of Girona, and Santa Caterina Hospital of Salt, Girona, Spain – sequence: 2 givenname: Beatriz surname: Raboso Moreno fullname: Raboso Moreno, Beatriz organization: Department of Pulmonology, Getafe University Hospital, Madrid, Spain – sequence: 3 givenname: Blanca surname: Urrutia-Royo fullname: Urrutia-Royo, Blanca organization: Pulmonology Department, Maresme Health Consortium – Mataró University Hospital, Barcelona, Spain – sequence: 4 givenname: Imanol surname: González Muñoz fullname: González Muñoz, Imanol organization: Pulmonology Department, Cruces University Hospital, Barakaldo, Spain – sequence: 5 givenname: Marta surname: Erro Iribarren fullname: Erro Iribarren, Marta organization: Pulmonology Department, Puerta de Hierro University Hospital, Madrid, Spain – sequence: 6 givenname: Cristina surname: Pou Álvarez fullname: Pou Álvarez, Cristina organization: NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IISGS), Álvaro Cunqueiro Hospital, Vigo, Spain – sequence: 7 givenname: Jessica surname: González Gutiérrez fullname: González Gutiérrez, Jessica email: jgonzalezgutierrez88@gmail.com organization: Arnau de Vilanova y Santa Maria University Hospital, Lleida, Spain |
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| Keywords | Resistencia a múltiples fármacos, bacteriana Neumonía asociada a la atención sanitaria Drug resistance, multiple, bacterial Pneumonia, ventilator-associated Healthcare-associated pneumonia Neumonía asociada a ventilación |
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| SubjectTerms | Drug resistance, multiple, bacterial Healthcare-associated pneumonia Neumonía asociada a la atención sanitaria Neumonía asociada a ventilación Pneumonia, ventilator-associated Pulmonary/Respiratory Resistencia a múltiples fármacos, bacteriana |
| Title | Nosocomial and Ventilator-associated Pneumonia |
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