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Probiotics for Ventilator-Associated PneumoniaProbiotics for Ventilator-Associated Pneumonia: The Need for a Large, Multicenter, Randomized Controlled Trial

Anthony F. Boyer, MD; Marin H. Kollef, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine.

Correspondence to: Marin H. Kollef, MD, FCCP, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63021; e-mail: mkollef@dom.wustl.edu


Funding/Support: Dr Kollef’s efforts were supported by the Barnes-Jewish Hospital Foundation.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Kollef is a consultant for Jansen Pharmaceuticals and is an advisor to Cubist Pharmaceuticals. Dr Boyer has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):590-592. doi:10.1378/chest.12-2139
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Ventilator-associated pneumonia (VAP), defined as pneumonia occurring >48 h after the initiation of mechanical ventilation, is the most common hospital-acquired infection in the ICU.1 Although the impact of VAP on mortality is controversial in patients dying from or with VAP, most studies demonstrate an increased attributable mortality.2,3 VAP also prolongs mechanical ventilation, increases the duration of ICU and hospital stays, accounts for more antibiotic consumption, and generates more costs related to treatment.4,5 Current methods used to diagnose VAP have limited accuracy, and there is poor agreement among clinical and surveillance methods.6 As a result, the National Healthcare Safety Network, the hospital-acquired infection surveillance system of the US Centers for Disease Control and Prevention, created a new surveillance algorithm for ventilator-associated events.7 This streamlined and objective surveillance system focuses on changes in ventilator parameters indicative of worsening oxygenation (ie, an increase in the fraction of inspired oxygen or the positive end-expiratory pressure after a period of stability) and hopes to identify a broader range of potentially preventable clinical conditions associated with mechanical ventilation.7 However, VAP still represents an important infection requiring prevention, not only due to its associated morbidity and mortality excess, but also due to the increased occurrence of VAP due to antibiotic-resistant bacteria.8,9

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