Table 5.
Research areas for HAP/VAP
| Research area | Outcome | ||
|---|---|---|---|
| Diagnosis |
Type of respiratory sample (invasive vs noninvasive) Culture method (quantitative vs quantitative/semiquantitative) |
- Diagnostic accuracy - Antibiotic use - Antibiotic resistance - Direct and indirect costs |
|
| Biomarkers (CRP, PCT) | Diagnostic accuracy | ||
| Clinical scores (CPIS) | Diagnostic accuracy | ||
| Surveillance cultures |
- Time to diagnosis - Diagnostic accuracy |
||
| Treatment | Newer BL/BLIs | Clinical and microbiological outcome (ASPECT, REPROVE trial) | |
| Different antibiotic regimens |
Long-term outcomes - Individual (C. difficile infection) - Community (MDR) |
||
| Factors to guide narrow vs broad-spectrum treatment | |||
| Carbapenem use | Long-term safety | ||
| Inhaled antibiotics | Optimal delivery method |
- Duration of systemic antibiotics - Clinical and microbiological outcome |
|
| Optimal dosage | |||
| De-escalation | Fixed-dose vs de-escalation | Clinical and microbiological outcomes | |
| Duration of treatment | Biomarkers (CRP, PCT) |
- Determination of treatment duration - Time to safely stop treatment - Population to safely stop treatment |
|
| Clinical scores (CPIS) | |||
| Pathogen-specific treatment | |||
| Pseudomonas aeruginosa | Different treatment regimens | Clinical and microbiological outcome | |
| Combination vs monotherapy in septic shock | Clinical and microbiological outcome | ||
| Different treatment regimens | Clinical and microbiological outcome | ||
| ESBL pathogens | Different treatment regimens | Clinical and microbiological outcome | |
| CR pathogens | Carbapenem efficacy | ||
| Acinetobacter spp. | Inhaled colistin |
- Dosage - Delivery method - Clinical and microbiological outcomes |
|
| Prevention | Selective oral decontamination |
- Long-term outcomes, especially in high baseline resistance settings - Resistance emergence |
|
| Prevention of VAP, but no data on other outcomes—MV days, ICU length of stay, mortality | |||
| Oral care with chlorhexidine | - Safety | ||
| Prophylactic probiotics | |||
| Ultrathin polyurethane endotracheal tube cuffs | |||
| Automated control of endotracheal tube cuff pressure | |||
| Instill saline before tracheal suctioning | |||
| Mechanical tooth brushing | |||
BL/BLIs, beta-lactam/beta-lactamase inhibitors; ESBL, extended spectrum beta-lactamase; CPIS, clinical pulmonary infection score; CR, carbapenem-resistant; CRP, C reactive protein; MDR, multidrug resistant; MV, mechanical ventilation; PCT, procalcitonin