Ventilator-associated pneumonia related to ESBL-producing gram negative bacilli
Ventilator-associated pneumonia (VAP) is one of the most frequent cause of intensive care unit (ICU) acquired infections. The worldwide spreading of extended spectrum beta-lactamase producing enterobacteriaceae (ESBL-PE) represents a major problem encountered more and more frequently in ICU. Among ICU patients, between 5% to 25% are ESBL-PE carriers. Whereas, previous carriage is the major risk factors associated with VAP related to ESBL-PE, among carriers, only 5% to 20% will develop a VAP related to ESBL-PE. Also, diagnosis and therapeutic delay are associated with length of stay and higher morbidity, and mortality, therefore, early identification of patients at risk of ESBL-PE related infections is crucial for early implementation of effective antibiotic therapy. VAP related to ESBL-PE should be considered in: previous colonized patients in case of late onset pneumonia and/or when several antibiotic courses precede the infectious episode or even in patients with shock. Among non-colonized patients, if VAP occurs, the risk being related to ESBL-PE is less than 1%. In the future, new rapid microbiological diagnostic tests will allow an early diagnosis. According to recent data, empirical antibiotic therapy should be based on carbapenems. Other alternative antibiotic classes could be used for de-escalation. However, several pharmacodynamic and pharmacokinetics precautions should be taken to achieve drug concentrations at site of infection and except to cure the infected patient.