Antibiotic therapy in ventilator-associated tracheobronchitis: a literature review

Abstract

The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.

Enteral antipseudomonal fluoroquinolones for ventilator‐associated tracheobronchitis in children with pre‐existing tracheostomy

“…A 2014 survey of providers in 16 countries reported diagnosing VAT based on both microbiological and clinical criteria (79.2%), and over half (50.3%) believe antibiotics should be utilized for the treatment of VAT 32 . One of the challenges with the treatment of VAT continues to be the variation in criteria for diagnosis, and there is no consensus on reference values or quantitative data that should be used 31,33 . Depending on the diagnostic criteria utilized, 4,8,26,28,34 26%–74% of patients in this study would have been diagnosed with VAT.…”

“…32 One of the challenges with the treatment of VAT continues to be the variation in criteria for diagnosis, and there is no consensus on reference values or quantitative data that should be used. 31,33 Depending on the diagnostic criteria utilized, 4,8,26,28,34 As with other existing literature, the severity of illness is not addressed in this study, in which patients with more mild and selflimiting illnesses may have infection resolution without antibiotics. Additionally, patients with positive RVP results may have had selflimiting viral infections and not VAT.…”

Enteral Ciprofloxacin or Levofloxacin for Ventilator-Associated Tracheobronchitis in Children

“…A 2014 survey of providers in 16 countries reported diagnosing VAT based on both microbiological and clinical criteria (79.2%), and over half (50.3%) believe antibiotics should be utilized for treatment of VAT 24 . One of the challenges with treatment of VAT continues to be the variation in criteria for diagnosis, and there is no consensus on reference values or quantitative data that should be used 23,25 . Depending on the diagnostic criteria utilized 1,3,18,20,26 , 26% to 74% of patients in this study would have been diagnosed with VAT.…”

Outcomes of Mechanically Ventilated Patients With Nosocomial Tracheobronchitis

“…Hyperglycemia was found as a risk factor for high Pseudomonas aeruginosa density along with prolonged mechanical ventilation greater than 28 days and respiratory disorders that were diagnosed when admitted to the ICU. Alves et al found that using antibiotic therapy does not improve the prognosis of VAT as it does not reduce the risk of mechanical ventilation, mortality, and hospitalization but reduces progression to pneumonia due to ventilator [17]. Moreover, Hashemi et al diagnosed VAT on the basis of fever, presence of mucus and tracheal secretions, and no lung involvement [18].…”