What We Learned From the EU-VAP/CAP Study for Severe Pneumonia

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EU-VAP/CAP is the largest observational, multicenter, international study conducted in Europe, focusing on severe pneumonia in the intensive care unit. It provided important insights into the different aspects of diagnostics and management of severe community-acquired pneumonia (CAP) and nosocomial pneumonia. Incidence, specificities of early-onset and late-onset settings, microbiologic etiology, antimicrobial prescription, and outcomes were analyzed, with a closer look at ventilator-associated pneumonia (VAP). Distinct populations showing specific risk factors, and outcomes were set (trauma VAP, elderly VAP, chronic obstructive pulmonary disease VAP), stressing VAP variety and complexity. This review assesses EU-VAP/CAP findings that opened perspectives on future research: the role of antibiotic choice in reducing severe CAP mortality, the study of a very early-onset VAP subset, the high frequency of potential resistant microorganisms in VAPs without known risk factor for resistance, the importance of describing specific VAP subpopulations (trauma, elderly, chronic obstructive pulmonary disease), and the insufficiency of nurse-to-patient ratio index to assess the nursing impact on VAP occurrence. The EU-VAP/CAP study comprehensively helped portray the picture of severe pneumonia across Europe and clarify the main themes that need to be scrutinized in the near future to reduce the heavy burden of severe CAP and VAP.

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