Ventilator-associated pneumonia Part 1: epidemiology, pathogenesis and prevention

Ventilator-associated pneumonia [VAP] is the leading cause of morbidity and mortality in intensive care units [ICUs]. Intubation and mechanical ventilation [MV] is associated with a 7-fold to 21 -fold increase in the incidence of pneumonia and approximately one third of patients receiving mechanical ventilation will develop this complication. Prevention of VAP must be regarded as one of the most important issues in critical care. It is possible through the use of several evidence-based strategies intended to minimize intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. Important components of effective preventive strategies focus on basic infection control principles like hand washing, adequate ICU staff education, and optimal resource utilization. Measures to prevent VAP extend into all aspects of daily intensive care practice, including antibiotic selection and duration of use, preferred routes of intubation, limitation of sedation, protocolized weaning, optimal use of noninvasive mask ventilation, patient positioning, ventilator circuit management, transfusion practices, stress ulcer prophylaxis, and glycemic control. However, strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. In the first part of this article we review the evidence on prevalence, pathogenesis, microbiology, and prevention of VAP. Evidence-based recommendations for prevention of VAP are provided. Diagnosis and treatment of this condition are discussed in part two

Tuberculosis in HIV-infected patients

The resurgence of tuberculosis worldwide is largely linked to the human immunodeficiency virus [HIV] epidemic. Epidemiology data have demonstrated that HIV-infected individuals are more susceptible to myocobacterial disease, which may lead to an acceleration in the progression of HIV disease. Diagnosis of tuberculosis in patients infected with HIV is sometimes difficult because of atypical clinical and radiographic findings. In the present article we review the epidemiological interactions of HIV and tuberculosis and discuss clinical and radiological manifestations and treatment of tuberculosis in HIV-infected patients