TABLE 5.
Chronological trend of recommendations on drug treatment of VAP.
| Guideline | Empiric Treatment Recommendation (SOR/LOE) | Aerosolized Antibiotics Recommendation (SOR/LOE) | Duration of Antibiotic Therapy (SOR/LOE) |
|---|---|---|---|
| Qiu, HB 2021 (Association SoCRDoCM 2021) | —— | For VAP/HAP patients infected with multidrug-resistant gram-negative bacteria, systemic antibiotics combined with aerosol inhalation antibiotics can be considered to improve the cure rate of pneumonia and the clearance rate of respiratory bacteria (Weak/Low) | —— |
| Qu, JM 2018 (Infectious disease group RmboCMA 2018) | For HAP/VAP patients with risk factors of MDR Pseudomonas aeruginosa and other MDR gram-negative bacilli infection or high risk of death, the use of two different types of antibiotics in combination is recommended; For patients with HAP/VAP who are not critical/have no risk factors for MDR infection, a single antibiotic can be used in empirical treatment (Strong/Low) | —— | —— |
| Lenoe, M. 2018 (Leone et al., 2018) | —— | The administration of nebulized colimycin (sodium colistimethate) and/or aminoglycosides is suggested in documented HAP due multidrug-resistant Gram-negative bacilli documented pneumonia established as sensitive to colimycin and/or aminoglycoside, when no other antibiotics can be used (based on the results of susceptibility testing) *Data are only available for VAP (GRADE 2+) | The antibiotic treatment for HAP for longer than 7 days is not recommended, including for non-fermenting Gram-negative bacilli, apart from specific situations (immunosuppression, empyema, necrotizing or abscessed pneumonia) * Data are only available for VAP (GRADE 1-) |
| Torres, A. 2017 (Torres et al., 2017) | It is recommended that empiric treatment regimens be informed by the local distribution of pathogens associated with VAP and their antimicrobial susceptibilities. (See Supplementary File S6 for details) | —— | Using a 7–8-days course of antibiotic therapy is suggested in patients with VAP without immunodeficiency, cystic fibrosis, empyema, lung abscess, cavitation, or necrotizing pneumonia and with a good clinical response to therapy (Weak recommendation, moderate quality of evidence) |
| Kalil, A.C. 2016 (Kalil et al., 2016) | It is recommended that empiric treatment regimens be informed by the local distribution of pathogens associated with VAP and their antimicrobial susceptibilities. (See Supplementary File S6 for details) | Both inhaled and systemic antibiotics, rather than systemic antibiotics alone are suggested for patients with VAP due to gram-negative bacilli that are susceptible to only aminoglycosides or polymyxins (colistin or polymyxin B) (Weak recommendation, very low-quality evidence) | For patients with VAP, a 7-days course of antimicrobial therapy rather than a longer duration is recommended (Strong recommendation, moderate-quality evidence) |
| Li, YM 2013 (Association CcmboCM 2013) | The initial empirical anti-infective treatment of VAP patients is usually single drug anti-infective treatment with appropriate antibacterial spectrum; If the pathogen is multi drug resistant, the combination treatment of antibiotics can be selected (1B) | For pulmonary infection caused by multidrug-resistant non fermenting bacteria, when the effect of systemic anti infection treatment is poor, combined aerosol inhalation of aminoglycosides or polymyxin and other drugs can be considered (1C) | VAP anti infection course is generally 7–10 days. If the patient has poor clinical response, multi drug resistant bacterial infection or immune function defect, the treatment time can be appropriately prolonged (1B) |
| Gupta, D. 2012 (Gupta et al., 2012) | There is no evidence to suggest that combination therapy is superior to monotherapy (1A) | Aerosolized antibiotics (colistin and tobramycin) may be a useful adjunct to intravenous antibiotics in the treatment of MDR pathogens where toxicity is a concern and should not be used as monotherapy but should be used concomitantly with intravenous antibiotics (2A) | In patients with VAP due to Pseudomonas, Acinetobacter, and MRSA, a longer duration (14 days) of antibiotic course is recommended; In other patients with VAP who are clinically improving, a 7-days course of antibiotics is recommended (1A) |
HAP: Hospital-acquired Pneumonia; VAP: Ventilator-associated Pneumonia; MRSA: Methicillin-resistant Staphylococcus aureus; MDR: Multidrug resistance; SOR: Strength of recommendation; LOE: Level of evidence.