CLINICAL MANAGEMENT AND THERAPEUTIC CHALLENGES OF VENTILATOR-ASSOCIATED PNEUMONIA CAUSED BY DRUG-RESISTANT BACTERIA IN INTENSIVE CARE UNITS

Abstract

Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Gram-negative bacteria is a major cause of morbidity, mortality, and prolonged length of stay in Intensive Care Units (ICU). Objective: To analyze the scientific evidence regarding the clinical management, etiological profile, resistance determinants, and pharmacological innovations in the treatment of VAP caused by resistant pathogens. Methods: An integrative review searching studies published in the last five years across PubMed/MEDLINE and LILACS via the Virtual Health Library (VHL). Results and Discussion: Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia emerged as the predominant pathogens, displaying high rates of carbapenem resistance and production of serine- and metallo-beta-lactamases (MBLs). New beta-lactamase inhibitor combinations and the siderophore cephalosporin (cefiderocol) demonstrated potential clinical efficacy. For PDR strains producing MBLs, rescue combinations such as ceftazidime-avibactam plus aztreonam and dual-carbapenem therapy (DCT) contributed to the improvement of organ dysfunction. Additionally, inhaled polymyxin administration stood out by increasing tissue concentrations while reducing the risk of acute kidney injury. Conclusion: Prompt initiation of appropriate empirical antibiotic therapy, aligned with local antibiograms and rapid molecular diagnostic technologies, appears to be the primary driver in reducing mortality among these patients.