Aerosolized Antibiotics for Ventilator Associated Infections 28 November 2018 Linda Le Introduction/background In the intensive care unit
Aerosolized Antibiotics for Ventilator Associated Infections
28 November 2018
In the intensive care unit, patients are at a high risk of death not only due to their critical illness but also from secondary processes such as Ventilator-associated infections. Of these many infections susceptible to the patient, Ventilator-associated pneumonia (VAP), is the most common form of hospital-associated pneumonia. This specific case develops due to the use of mechanical ventilation systems and is contracted in less than 48 hours post introduction. In regards to patients with nosocomial infections, ventilator- associated pneumonia is the leader in mortality rates. In addition to this, patients are typically hospitalized for up to two weeks, in turn acquiring extra hospital expenses. All population groups are affected, but patients with VAP are more likely to be older, sicker, and male, with invasive medical devices in place. Early VAP diagnosis is desirable to reduce VAP mortality and to prevent the emergence of multidrug-resistant microbes. Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semi recumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to “fill the gap” or prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Also, hospital water should be Legionella-free, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor (HEPA) filtered air.