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The Role of the Intensive Care Unit Environment in the Pathogenesis and Prevention of Ventilator-Associated Pneumonia

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Abstract:

Ventilator-associated pneumonia is preceded by lower-respiratory-tract colonization by pathogenic microorganisms that derive from endogenous or exogenous sources. Most ventilator-associated pneumonias are the result of exogenous nosocomial colonization, especially, pneumonias caused by resistant bacteria, such as methicillin-resistant Staphylococcus aureus and multi-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, or by Legionella species or filamentous fungi, such as Aspergillus. Exogenous colonization originates from a very wide variety of animate and inanimate sources in the intensive care unit environment. As a result, a strategic approach that combines measures to prevent cross-colonization with those that focus on oral hygiene and prevention of microaspiration of colonized oropharyngeal secretions should bring the greatest reduction in the risk of ventilator-associated pneumonia. This review examines strategies to prevent transmission of environmental pathogens to the vulnerable mechanically-ventilated patient.

Keywords: VENTILATOR-ASSOCIATED PNEUMONIA

Document Type: Research Article

Affiliations: 1: Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, University of Wisconsin Center for Health Sciences, Madison, Wisconsin 2: Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, University of Wisconsin Center for Health Sciences, Madison, Wisconsin, Center for Trauma and Life Support, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison WI 53792;, Email: dgmaki@facstaff.wisc.edu

Publication date: June 1, 2005

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