Intensive care for pneumonia patients needs improving

The treatment options available to ventilated patients in Dutch intensive care units needs improving. This was the conclusion drawn by intensive care physician Jan Scholte in his dissertation for which he hopes to obtain his doctoral degree on 28 January at Maastricht University. According to Scholte, intensive care units wrongly assess patients based on when the pneumonia occurred (early or late onset). ‘Under the current ICU protocols, this could lead to over or undertreatment and even death.'

Pneumonia is one of the most common complications in ventilated patients. For this reason, surveillance cultures are taken of ventilated patients at three-quarters of all ICU units in the country, with the goal of tailoring treatment to the individual needs of the patient. The question, however, is whether these cultures have any added value.

Scholte found that surveillance cultures are particularly useful for detecting microorganisms that are resistant to commonly used antibiotics and for high-risk patients who are more susceptible to infections. If the culture sample suggests that the patient may not respond to traditional antibiotics, an alternative method can be used to treat a suspected bacterial infection. With more and more bacteria becoming resistant to commonly used antibiotics, Scholte suggests prescribing different types of antibiotics in some cases. A database based on his research data may serve as a useful guideline in the future.
Scholte also found discrepancies in the results of two frequently used tests to detect pneumonia in an ICU setting. Current guidelines indicate that these tests can be used to diagnose pneumonia. Given these discrepancies, however, it is important to determine the best test for diagnosing pneumonia. This requires further research.  

Scholte, who worked as an ICU doctor at Maastricht UMC+ before transferring to the Luzerner Kantonsspital in Switzerland as an assistant medical director, discovered that some bacteria are not as harmful as previously believed. Harmless commensal throat flora and Stenotrophomonas maltophilia can also lead to pneumonia. The latter is believed to cause one in ten cases of pneumonia in ventilated patients, likely as a result of a compromised immune system.

While his research has brought several issues to light, there are still several uncertainties that require further research. 'The clinical definition of ventilation-related pneumonia as well as the best diagnostic method and the mortality rate of ventilated pneumonia patients remains open to discussion,' says the PhD candidate.

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