Clinical Scenario

This protocol addresses patients with ventilator-associated pneumonia (VAP) in whom the causative pathogen is carbapenem-resistant and retains sensitivity only to polymyxins — a presentation that narrows the available therapeutic options considerably.

The core challenge in this scenario is managing VAP when standard first-line agents are no longer active against the pathogen. Selecting and optimising an appropriate polymyxin-based regimen is critical to achieving clinical resolution.

Treatment Approach (partial)

The recommended approach centres on intravenous polymyxins as the primary backbone, with adjunctive inhaled therapy as an additional strategy — the specific agents, combination rationale, and course structure are detailed in the full protocol.

Full regimen, sequencing, and evidence ratings available below ↓

References

DOI: 10.1093/cid/ciw353

In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin B) (strong recommendation, moderate-quality evidence), and we suggest adjunctive inhaled colistin (weak recommendation, low-quality evidence).
For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration (strong recommendation, moderate-quality evidence).

View source ↗

Treatment of Ventilator-Associated Pneumonia Due to a Carbapenem-Resistant Pathogen Sensitive Only to Polymyxins

References