Document Detail


Ventilator-associated pneumonia: problems with diagnosis and therapy.
MedLine Citation:
PMID:  18831297     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The diagnosis of ventilator-associated pneumonia, VAP, is problematic because of a lack of objective tools that are utilized to make an assessment of bacterial-induced lung injury in a heterogeneous group of hosts. Clinical symptoms and signs are used to identify patients that may have a "lung infection". However, the symptoms and signs can be produced by a myriad of other conditions. Recent clinical data also suggests bacterial-induced pathologic processes occur prior to the onset of the symptoms and signs. Utilizing bacterial culture alone, health care practitioners are forced to wait for days for results and will have to order days of empiric antibiotic therapy. Exploratory molecular studies utilizing clone libraries and molecular arrays for microbial identification document the inability of culture-based techniques to even identify all the microbes involved in VAP. These molecular studies also offer evidence that oral flora present in the lungs of patients with VAP, suggesting aspiration of oral secretions and/or biofilms on endotracheal tubes, supply the bacteria for VAP. Much more investigation is needed to determine the optimal timing of antibiotic treatment and which diagnostic molecular methods can be utilized in the ICU.
Authors:
Jeanine P Wiener-Kronish; Henry Isaiah Dorr
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Best practice & research. Clinical anaesthesiology     Volume:  22     ISSN:  1521-6896     ISO Abbreviation:  Best Pract Res Clin Anaesthesiol     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-10-03     Completed Date:  2009-01-14     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  101121446     Medline TA:  Best Pract Res Clin Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  437-49     Citation Subset:  IM    
Affiliation:
Harvard Medical School, Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. jwiener-kronish@partners.org
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use*
Bacteriological Techniques
Colony Count, Microbial
Humans
Pneumonia, Ventilator-Associated / diagnosis*,  drug therapy*,  microbiology
Risk Factors
Ventilators, Mechanical / adverse effects*,  microbiology*
Grant Support
ID/Acronym/Agency:
HL6909/HL/NHLBI NIH HHS; HL74005/HL/NHLBI NIH HHS; P50 HL074005-010002/HL/NHLBI NIH HHS; P50 HL074005-019001/HL/NHLBI NIH HHS; R01 HL069809-02S1/HL/NHLBI NIH HHS; U01 AI075410-01/AI/NIAID NIH HHS; U01 AI1075410/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections

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