Prevention of hospital-acquired pneumonia: European perspective

Prevention of ventilator-associated pneumonia (VAP) has been a subject of intensive study in European ICUs since the 1980s. Several antibiotic-containing preventive strategies seem to be very effective in different patient populations. Selection of antibiotic resistance remains the major disadvantage of these strategies, however, limiting applicability in settings with high levels of antibiotic resistance. There is little evidence that systemic prophylaxis is effective for the prevention of VAP, and initial studies were associated with resistance problems. Of the non-antibiotic-containing preventive strategies, subglottic aspiration was effective in several studies. Other strategies were effective in single studies, and more data are needed on the generalizability, feasibility, and cost-effectiveness of these interventions.