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Antibiotic Therapy of Ventilator-Associated Pneumonia : In Search of the Magic Bullet

Christian Brun-Buisson, MD
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Affiliations: Créteil, France
 ,  Dr. Brun-Buisson is associated with the Service de Rénimation Medical & Unité d’Hygiène et Prevention de l’Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris.

Correspondence to: Christian Brun-Buisson, MD, Service de Réanimation Médicale & Unité d’Hygiène et Prévention de l’Infection, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), 51 Ave du Maréchal de Lattre de Tassigny, 94010, Créteil, France; e-mail: christian.brun-buisson@hmn.ap-hop-paris.fr



Chest. 2003;123(3):670-673. doi:10.1378/chest.123.3.670
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Pneumonia occurring during mechanical ventilation, the so-called ventilator-associated pneumonia (VAP), is the major cause of infection in critically ill patients who are receiving mechanical ventilation. Accordingly, lower respiratory tract infection is the major reason for prescribing antibiotics to patients in the ICU.1 Given the current trends in antimicrobial resistance,2 the fact that ICUs are the major source and reservoir of resistant strains3 and inasmuch as resistance is, at least in part, linked to antibiotic use, there is both a strong rationale and an incentive for designing antibiotic policies for the management of infection in the ICU that are aimed at controlling or reducing patient resistance, especially for therapy in patients with respiratory tract infections.3 Toward this end, several approaches have been advocated, including restrictive formularies, the rotation of antibiotics, and the use of specific diagnostic techniques, which result in the empirical treatment of fewer patients with clinically suspected pneumonia.45

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