Nosocomial pneumonia in the intensive care unit: how should treatment failure be predicted? - Critical Care Science (CCS)

Nosocomial pneumonia in the intensive care unit: how should treatment failure be predicted? |

INTRODUCTION

Intensive care unit-acquired pneumonia (ICUAP) is the most common infection acquired by critically ill patients and leads to poor patient outcomes, such as prolonged hospital stays and high associated costs.^{( , )} ICUAP includes pneumonia acquired during ICU stays of patients under mechanical ventilation (ventilator-associated pneumonia, or VAP), as well as of non-ventilated patients (NV-ICUAP). Although the current literature contains few studies examining NV-ICUAP, it has been suggested that both diagnoses present with similar pathogens and, depending on case-mix, similar outcomes.^{( )}

ICUAP remains a major cause of morbidity and mortality^{( , )} despite advances in antimicrobial therapy, supportive care, and the use of a broad range of preventive measures.^{( , )} Several factors that likely play a role in the poor outcomes of ICUAP patients include illness severity, the presence of pre-existing conditions, and the host response to infection.^{( , )} Early and adequate empirical treatment is also a crucial prognostic determinant. The weight that each of these factors has on influencing final patient outcomes has been a matter of debate for decades, with recent studies reporting a small attributable mortality to VAP after applying appropriate analysis.^{( )}

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