Guidelines for the therapy of nosocomial pneumonia, including ventilator-associated pneumonia (VAP) and healthcare-associated pneumonia, have been published by the American Thoracic Society and the Infectious Diseases Society of America, in 2005, and are in need of updating. The basic approach, which has not changed, is to ensure timely and appropriate therapy for all patients, focusing on identifying those at risk of infection by multidrug-resistant pathogens, including extended-spectrum &bgr;-lactamase producing Gram-negative bacteria, Acinetobacter spp., Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA).
In the delivery of adequate antimicrobial therapy it is important to ensure that patients receive the correct dose of antibiotic and, in the case of multidrug-resistant pathogens, to administer regimens that optimise drug pharmacokinetics. New options for the treatment of multidrug-resistant Gram-negative bacteria have emerged with the availability of doripenem and tigecycline, the re-emergence of colistin and the use of aerosolised antibiotic therapy. The role of combination therapy in patients with VAP has been clarified and therapy for MRSA VAP has been evaluated with new data focusing on the use of telavancin and linezolid. To optimise antibiotic use for nosocomial pneumonia, it is essential to have a good knowledge of each intensive care unit’s dominant organisms and ensure proper antimicrobial stewardship, focusing on de-escalation and optimal duration of antibiotic therapy.