Is ventilated hospital-acquired pneumonia a worse entity than ventilator-associated pneumonia?

Abstract

IntroductionNosocomial pneumonia develops after ≥48 h of hospitalisation and is classified as ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP); the latter may require mechanical ventilation (V-HAP) or not (NV-HAP).Main findingsVAP and HAP affect a significant proportion of hospitalised patients and are characterised by poor clinical outcomes. Among them, V-HAP has the greatest 28-day mortality rate followed by VAP and NV-HAP (27.8% versus 18% versus 14.5%, respectively). However, no differences in terms of pathophysiology, underlying microbiological pathways and subsequent therapy have been identified. International guidelines suggest specific flow charts to help clinicians in the therapeutic management of such diseases; however, there are no specific recommendations beyond VAP and HAP classification. HAP subtypes are scarcely considered as different entities and the lack of data from the clinical scenario limits any final conclusion. Hopefully, recent understanding of the pathophysiology of such diseases, as well as the discovery of new therapies, will improve the outcome associated with such pulmonary infections.ConclusionNosocomial pneumonia is a multifaced disease with features of pivotal interest in critical care medicine. Due to the worrisome data on mortality of patients with nosocomial pneumonia, further prospective studies focused on this topic are urgently needed.

Hospital-Acquired Pneumonia: The Lebanese Societies for Pulmonary, Critical Care, and Infectious Diseases and Clinical Microbiology Joint Guidelines

“… The guidelines of the Spanish Society of Chemotherapy for antibiotic selection in the treatment of acute invasive infections by P. aeruginosa (79). (17,18). Therefore, optimal antibiotic therapy should be selected and guided by local susceptibility rates and MDROs risk factors.…”

Ceftolozane/tazobactam versus meropenem in patients with ventilated hospital-acquired bacterial pneumonia: subset analysis of the ASPECT-NP randomized, controlled phase 3 trial

“…Pneumonia, including hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP), is the most common healthcare-acquired infection in the intensive care unit and is associated with high mortality rates of ~ 20–50% [ 1 – 3 ]. HABP is classified as bacterial pneumonia that develops in patients who have been hospitalized for ≥ 48 h, while VABP is defined as bacterial pneumonia developing after ≥ 48 h of endotracheal intubation [ 2 – 4 ]. Patients with HABP who progress to respiratory failure severe enough to require mechanical ventilation (vHABP) represent a more clinically severe subtype of the disease than patients with nonventilated HABP [ 4 ].…”

“…HABP is classified as bacterial pneumonia that develops in patients who have been hospitalized for ≥ 48 h, while VABP is defined as bacterial pneumonia developing after ≥ 48 h of endotracheal intubation [ 2 – 4 ]. Patients with HABP who progress to respiratory failure severe enough to require mechanical ventilation (vHABP) represent a more clinically severe subtype of the disease than patients with nonventilated HABP [ 4 ]. Randomized controlled trials evaluating antibacterial treatment of HABP/VABP consistently demonstrate higher mortality in participants with vHABP compared with VABP or nonventilated HABP [ 1 , 5 ].…”

“…Clinical research in nosocomial pneumonia has tended to focus more on VABP than HABP, with even less focus specifically on the vHABP subgroup. The limited number of available published studies do not report substantial differences between VABP and HABP in terms of underlying microbiology or pathophysiology [ 4 , 6 ]. Given the especially high mortality associated with vHABP, new treatment options are particularly needed for this nosocomial pneumonia subtype [ 1 ].…”

Nosocomial Pneumonia in the Era of Multidrug-Resistance: Updates in Diagnosis and Management

“…VAP represents the vast majority of cases of NP in the ICU [ 4 ]. Patients with severe HAP may deteriorate further and subsequently need endotracheal intubation (ventilated HAP) [ 5 ]. Despite efforts to improve the diagnosis and management of NP, morbidity and mortality rates remain high, with mortality rates of VAP ranging from 24 to 50%, jumping to 76% if multi-drug resistant pathogens are involved [ 6 , 7 , 8 ].…”