Ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: understanding nebulization of aminoglycosides and colistin.

The use of nebulized antibiotics for treating ventilatorassociated pneumonia (VAP) caused by multidrugresistant (MDR) Gram-negative bacteria (GNB) increases worldwide. There is a paradox, however, between the large body of experimental evidence supporting the administration of nebulized rather than intravenous aminoglycosides and colistin to treat inoculation pneumonia caused by GNB [1, 2], and the paucity of clinical studies confirming such a benefit in VAP. Based on the recommendations of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) [3, 4], the present article examines this apparent contradiction and suggests some directions for further research and clinical practice. [...