Patient selection: trauma patient treated for ventilator-associated pneumonia
A relapse was defined as a second episode of pneumonia caused by one of the same organisms isolated from the previous episode.
Risk factors for relapse of the VAP:
(1) VAP caused by a nonfermenting Gram-negative bacteria
(2) poor monitoring afterwards
Examples of nonfermenting Gram-negative bacteria:
(1) Pseudomonas
(2) Acinetobacter
(3) Stenotrophomonas
Additional risk factors to consider:
(1) suboptimal antibiotic regimen (wrong antibiotic, wrong dose, wrong duration, wrong route). Some antibiotics regimens will suppress the organism during therapy only to have re-emergence once the antibiotic is discontinued.
(2) duration of the ventilator support. The sooner the person is off the ventilator the less the risk of a relapse.
Differential diagnosis:
(1) continuation of the initial episode of pneumonia
(2) pneumonia caused by a different organism
