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In this article the authors discuss various studies on Pseudomonas aeruginosa and Candida albicans colonization in patients with ventilator-associated pneumonia (VAP). They note that the most common pathogens retrieved from endotracheal tube biofilm in intensive care unit (ICU) are P. aeruginosa and Candida species. The authors cite that P. aeruginosa remains responsible for severe lower respiratory tract infections despite considering the presence of Candida species in respiratory specimen as colonization.

Purpose of Review: Nosocomial tracheobronchitis is common among intubated critically ill patients. Ventilator-associated tracheobronchitis (VAT) represents an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia. The aim of this review is to discuss recent findings on VAT., Recent Findings: VAT is defined using all the following criteria: fever (>38 degrees C) with no other recognizable cause, purulent sputum production, positive culture of respiratory specimen at significant threshold, and no radiographic signs of new pneumonia. This infection is frequently caused by Pseudomonas aeruginosa and characterized by lower respiratory tract inflammation and increased sputum production resulting in weaning difficulties and longer duration of mechanical ventilation. The effect of aerosolized antibiotics on outcomes in VAT patients was evaluated in a randomized blinded placebo-controlled trial. Aerosolized antibiotics significantly increased weaning from mechanical ventilation and reduced subsequent ventilator-associated pneumonia and usage of systemic antibiotics and antibiotic resistance. A randomized unblinded controlled study assessed the impact of systemic antibiotics on outcome of VAT patients. Antibiotic treatment increased mechanical ventilation-free days and reduced the incidence of subsequent ventilator-associated pneumonia and ICU mortality., Summary: Antibiotic treatment is beneficial in VAT patients. Future studies should confirm these promising results and determine the best duration of antimicrobial therapy in these patients.

Purpose of Review: A bacterial cause is found in about half of all severe chronic obstructive pulmonary disease exacerbations. The aim of this review is to discuss recent findings regarding prevalence, risk factors and outcome of severe chronic obstructive pulmonary disease exacerbations caused by multidrug-resistant bacteria., Recent Findings: According to the results of recent studies, multidrug-resistant bacteria represented a large proportion of bacteria isolated in chronic obstructive pulmonary disease exacerbations. Prior antibiotic treatment, prior endotracheal intubation, long-term inhaled or systemic corticosteroid use and severe impairment of lung function were identified as risk factors for severe chronic obstructive pulmonary disease exacerbations related to multidrug-resistant bacteria. Although the mortality rate was higher in patients with multidrug-resistant bacteria as compared with patients with other bacteria, multidrug resistance was not independently associated with mortality in these patients. Multidrug-resistant bacteria were, however, significantly associated with inappropriate initial antibiotic treatment. Higher rates of subsequent ventilator-associated pneumonia and mortality were found in patients with severe chronic obstructive pulmonary disease exacerbation who received inappropriate initial antibiotic treatment when compared with those who received appropriate treatment., Summary: Further studies should determine whether administration of broad-spectrum antibiotic treatment could improve the outcome of patients with severe chronic obstructive pulmonary disease exacerbation caused by multidrug-resistant bacteria.