Ventilator-associated pneumonia monotherapy is optimal if chosen wisely 英文参考文献.docVIP

Available online /content/10/2/141 Commentary Ventilator-associated pneumonia: monotherapy is optimal if chosen wisely Burke A Cunha Infectious Disease Division, Winthrop-University Hospital, Mineola, New York and State University of New York School of Medicine, Stony Brook, New York, USA Corresponding author: Burke A Cunha, editorial@ Published: 20 April 2006 Critical Care 2006, 10:141 (doi:10.1186/cc4908) This article is online at /content/10/2/141 ? 2006 BioMed Central Ltd See related research by Damas et al. in this issue [/content/10/2/R52] Abstract The difficulties in determining the etiological agent in VAP are well known. Many patients with fever, leukocytosis, and pulmonary infiltrates on chest X-ray do not have VAP. Culture of organisms from respiratory secretions in ventilated patients does not imply a causal relationship to fever, leukocytosis, Traditionally, ventilator-associated pneumonia (VAP) has been treated either with double drug therapy or with monotherapy. Double drug therapy has been used to increase spectrum, for possible synergy, and to decrease the emergence of resistance. VAP therapy should be directed primarily against Pseudomonas aeruginosa, which also provides aerobic Gram-negative coverage, the usual pathogens in VAP. The potent anti-P. aeruginosa antibiotics available today have sufficient activity that double drug coverage is unnecessary. Double drug therapy does not decrease resistance if a ‘high resistance potential’ antibiotic is used in the combination. The study by Damas and colleagues in this issue of Critical Care supports monotherapy for VAP. Optimal therapy for VAP involves selecting a potent anti-P. aeruginosa antibiotic with a ‘low resistance potential’ that minimizes drug-drug interactions, minimizes resistance, and is cost effective. Monotherapy of VAP should be the standard of care. and pulmonary infiltrates,