Inhaled Antibiotics in the Treatment of Nosocomial Pneumonia

Nosocomial pneumonia (NP) — is a disease associat ed with a formation of new focal and infiltrative changes on the chest X ray 48 hrs after the hospitalization along with the clinical data confirming their infectious nature (fever, purulent sputum or purulent discharge from the tracheo bronchial tree, leukocytosis, etc.), excluding infections which were incubated on the admission [1]. Nosocomial pneumonia — is the most prevalent intensive care unit infection. The high prevalence of NP is due to the widespread and irrational use of antibiotics and artificial pulmonary ventilation. The Russian National data confirm that NP incidence in surgical patients is 6% after elective surgery and 15% after emergency surgery. The inci dence of ventilator associated pneumonia is 22% after elec tive surgery in ventilation longer than 2 days and 34,5% after emergency abdominal surgery; up to 55% in acute res piratory distress syndrome. Every day in intensive care unit stay increases the risk of NP by 3%. Nosocomial pneu monia significantly deteriorates the course of any disease, increase the duration of intensive care unit stay by 4,3—6,1 days and mortality. The attributable mortality of NP is between 5,8 to 27% [2—5]. The pathogenesis of NP in critically ill patients is based on an imbalance between the lung protective mecha nisms and microbial aggression. The lung can be infected either exogenously or endogenously. Aspiration of pharyn Nosocomial pneumonia is the most common nosocomial infection in intensive care units. Rational antibiotic therapy is the basis for the treatment of nosocomial pneumonia. There is currently a challenge of the pathogens of nosocomial pneumonia being resistant to most of the antibiotics recommended for its treatment. Inhaled antibiotics used in combination with sys temic drugs are an effective and safe treatment for nosocomial pneumonia. This review of literature characterizes the cur rent possibilities of inhaled antibiotic therapy for nosocomial pneumonia in detail and describes medicaments and the advantages and disadvantages of this treatment option. Despite insufficient evidence in circumstances where the microor ganisms are polyresistant and where the design of novel antibiotics shows no promise, the use of inhaled antibiotics is an important alternative in the treatment of severe nosocomial pneumonia caused by polyresistant gram negative bacteria.