Usefulness of Systematic Tracheal Aspirates for Ventilator-associated Pneumonia Management

Abstract

Ventilator-associated pneumonia (VAP) requires early and appropriate antibiotic treatment in order not to compromise patients’ outcome. Initial antibiotic treatment can be based upon two strategies. The first one, based on guidelines such as those delivered by the American Thoracic Society, is to administer broad spectrum antibiotics and to adapt the treatment when results of the microbiological cultures are available. This method has the disadvantage of encouraging the extensive use of broad spectrum antibiotics and promotes multiresistant bacteria emergence. Therefore, an alternative strategy was suggested, aiming to perform routine systematic cultures of tracheal aspirates in patients requiring mechanical ventilation. When VAP is suspected, initial antibiotic treatment can be adapted immediately to bacteria found in the systematic cultures of tracheal aspirates. Our analysis of the literature suggests that these tracheal aspirate cultures, performed twice a week, predict the responsible bacteria in most cases and allow adapting antibiotics and limiting broad spectrum antibiotic use in the intensive care unit.