New Therapeutic Approach for Ventilator-associated Pneumonia
Bacteriophages are viruses that infect bacteria in a species-specific way. In animal studies, phage therapy can both prevent and cure P. aeruginosa, Klebsiella pneumoniae and Streptococcus pneumoniae pneumonia.[146–149] These recent results may be a first basis towards further clinical trials, notably for difficult-to-treat MDR pathogens. Next, and despite an inappropriate bacterial spectrum, macrolides have immunomodulatory and anti-inflammatory effects that may be of interest in HAP/VAP. A short course of clarithromycin may ease the cure of otherwise adequately treated VAP and modulate the risk of death from septic shock or multiorgan failure.[151–152] Macrolides also inhibit P. aeruginosa quorum sensing, but the clinical impact of this property remains to be confirmed. Finally, in a recent RCT, monoclonal antibodies targeting the type III secretion system, a major pseudomonal virulence factor in pneumonia, reduced the incidence of VAP in patients with P. aeruginosa tracheal colonization. Further evaluation of immunotherapy in HAP/VAP is warranted.
Curr Opin Pulm Med. 2013;19(3):216-228. © 2013 Lippincott Williams & Wilkins