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Physicians' perceptions of current management strategies for Gram-negative pneumonia: a multinational study


Hospital-acquired pneumonia and its most serious manifestation, ventilator-associated pneumonia, are associated with high rates of mortality and account for 25% of all infections in the ICU [1]. Pneumonia in mechanically ventilated (MV) patients is often complicated by the involvement of multidrug-resistant (MDR) Gram-negative bacteria [2]. This multinational study explored physicians' prescribing behaviour when treating Gram-negative pneumonia in MV patients.


Online interviews were conducted with 510 critical/intensive care, infectious disease and pulmonary/respiratory specialists in the USA (n = 130), Germany (n = 100), Mexico (n = 100), Spain (n = 80) and Japan (n = 100). Participants were practicing physicians (3 to 31 years), were involved in the management of MV patients and were familiar with treatment strategies for pneumonia.


The involvement of Gram-negative (vs. Gram-positive) bacteria in pneumonia in MV patients was perceived to carry greater mortality risks. Most physicians (63 to 77% in all countries except Japan; 41% in Japan) were extremely concerned about the impact on treatment outcomes of increasing antibiotic resistance in Gram-negative species. Excessive antibiotic use and failure to effectively de-escalate antibiotic therapy were perceived as key contributors to resistance development. Achieving rapid cure (78%) and minimizing the duration of MV (76%) were cited as the most important aims of treatment. Key considerations for antibiotic selection were activity against Gram-negative bacteria, including MDR strains, and relative extent of lung tissue penetration. Over 80% of respondents saw aerosolized antibiotics as a valuable potential addition to the current treatment armamentarium (no antibiotic aerosols are currently licensed for pneumonia), particularly for elderly patients and those with respiratory distress, who are at risk of the worst outcomes.


Gram-negative pneumonia in MV patients is a serious complication in ICUs. Antibiotic prescribing for Gram-negative pneumonia among respondents is influenced by the risk of MDR bacterial involvement. Aerosolized antibiotics are seen as a potentially valuable adjunct to systemic therapies for treating Gram-negative pneumonia in MV patients.


  1. American Thoracic Society/Infectious Diseases Society of America: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005, 171: 388-416. 10.1164/rccm.200405-644ST.

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  2. Parker CM, et al: Ventilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes. J Crit Care. 2008, 23: 18-26. 10.1016/j.jcrc.2008.02.001.

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Frank, A. Physicians' perceptions of current management strategies for Gram-negative pneumonia: a multinational study. Crit Care 13 (Suppl 1), P338 (2009).

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  • Pneumonia
  • Mechanically Ventilate
  • Antibiotic Prescribe
  • Antibiotic Selection
  • Multinational Study