Ventilator-associated pneumonia (VAP) is a serious complication of critical illness. Surveillance definitions have undergone revisions for more objective and consistent reporting. The 1 organism–1 disease paradigm for microbial involvement may not adequately apply to many cases of VAP, in which pathogens are introduced to a pre-existing and often complex microbial community that facilitates or hinders the potential pathogen, consequently determining whether progression to VAP occurs. As omics technology is applied to VAP, a paradigm is emerging incorporating simultaneous assessments of microbial populations and their activity, as well as the host response, to personalize prevention and treatment.
Key points
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Surveillance definitions for ventilator-associated pneumonia (VAP) are in the process of being updated. Further evaluation is needed to assure that the patients who are most amenable to targeted prevention strategies are identified.
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VAP is the most common indication for antibiotic use in the pediatric intensive care unit. Present approaches to clinical cultures and antibiotic use may actually increase risk for VAP by depleting protective commensal organisms and selecting for antibiotic resistant pathogens.
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Recent metagenomic and proteomic technologies offer the potential to better interrogate the relationships between an intubated individual’s respiratory microbiota, the host’s immune response, and the underlying disease process to provide important insights into the pathogenesis of VAP.
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The normal lung is colonized with diverse microbial communities. It seems likely that critical illness and its care contribute to a dysbiosis and the selection of a disease-promoting microbiome or pathobiome that increases risk for nosocomial infection, including VAP.
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