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

Abstract

Nosocomial pneumonia (NP), including hospital-acquired pneumonia in non-intubated patients and ventilator-associated pneumonia, is one of the most frequent hospital-acquired infections, especially in the intensive care unit. NP has a significant impact on morbidity, mortality and health care costs, especially when the implicated pathogens are multidrug-resistant ones. This narrative review aims to critically review what is new in the field of NP, specifically, diagnosis and antibiotic treatment. Regarding novel imaging modalities, the current role of lung ultrasound and low radiation computed tomography are discussed, while regarding etiological diagnosis, recent developments in rapid microbiological confirmation, such as syndromic rapid multiplex Polymerase Chain Reaction panels are presented and compared with conventional cultures. Additionally, the volatile compounds/electronic nose, a promising diagnostic tool for the future is briefly presented. With respect to NP management, antibiotics approved for the indication of NP during the last decade are discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…The need for new drugs, especially as the COVID-19 pandemic continues, is perhaps the most important step our country needs to take in order to successful manage HAIs, both for COVID-19 patients and across other ICUs. In recent years, several drugs have been approved for treatment of MDR pathogens and different types of HAIs in the European Union (EU) and the United States (US) [58][59][60], both as standalone drugs and combination therapies, whereas a number of drugs are being investigated through clinical trials [61,62]. Aztreonam, considered an "old" drug, has also shown to be a useful agent in treating MDR infections as an adjunct to some of the recently approved antibiotics [63,64].…”

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

“…During the Coronavirus disease 2019 (COVID-19) pandemic, an unprecedented number of patients were admitted to intensive care units (ICUs) with COVID-19-related severe respiratory failure and underwent invasive mechanical ventilation (IMV) [ 1 ]. Invasive mechanical ventilation, especially if prolonged, is a risk factor for the occurrence of ventilator-associated pneumonia (VAP) [ 2 , 3 ]. Though there is no univocal definition of VAP, the most recent definitions suggest its identification by both radiological and clinical criteria, often combined with microbiological criteria [ 4 , 5 , 6 , 7 ].…”

Combination Therapy of Polymyxin B and Amikacin for Community-Acquired Pseudomonas aeruginosa Pneumonia with MODS in a Previously Healthy Patient: A Case Report

“…Comparing with conventional chest X-ray, CT can reveal small mild infiltrates which easily be neglected. 11 However, some lung pathologies have similar appearances on CT scan, it is difficult to establish the differential diagnosis in patients with various lung diseases, such as ARDS and pneumonia. Hence, pathogen culture and relevant drug-sensitive test should be performed as a supplement way to guide the diagnosis decision and therapeutic strategies.…”