Recurrent ventilator-associated pneumonias: the gift that keeps on giving or the guest who won't leave?

ABSTRACT

BACKGROUND: An increasing number of publications related to the concept of recurrent ventilator-associated pneumonia (VAP) has emerged in recent years. The clinical relevance of this publication trend could suggest failure to prevent VAP. METHODS: Review of articles addressing recurrent VAP, which were scrutinized for their definitions and methodology, seeking to determine the actual meaning of "recurrence." RESULTS: A preponderance of the early papers on recurrent VAP used definitions that create the possibility and even, in some cases, the likelihood that what was being addressed actually was persistent VAP. These studies, mostly from the same investigator group, considered "recurrent" VAP to appear as early as three days after the initial diagnosis while patients were still receiving antibiotics to treat that initial episode. The blurring of the concepts of "recurrence" and "persistence" is apparent in the methodology and the results. CONCLUSIONS: Existing evidence-based guidelines regarding the prevention and treatment of VAP should be applied to reduce the incidence of (i.e., prevent) and treat VAP effectively. A distinction should be made between "recurrence" and "persistence" in order to determine whether clinical inadequacies exist in preventive or therapeutic practices, respectively. An objective process for defining the resolution of VAP should be developed to enable this distinction to be made.