Antibiotic pharmacokinetics and pharmacodynamics: How can they be used to optimize therapy in ventilator-associated pneumonia?

Ventilator-associated pneumonia (VAP) is characterized by its high prevalence, and more importantly, by its fatal consequences. Although the overall incidence of nosocomial respiratory infections including VAP is lower than urinary tract infection, accounting for 15-20% of the total, it is the most common infection in intensive care unit (ICU) settings (1,2). While mechanical ventilation increases the risk of pneumonia by 3-to 10-fold, crude mortality rates for nosocomial pneumonia range from 24% to 76% (3).