{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:25:30Z","timestamp":1793215530385,"version":"4.5.0"},"reference-count":86,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T00:00:00Z","timestamp":1648339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Multidrug resistant organisms (MDRO) are commonly isolated in respiratory specimens taken from mechanically ventilated patients. The purpose of this narrative review is to discuss the approach to antimicrobial prescription in ventilated patients who have grown a new MDRO isolate in their respiratory specimen. A MEDLINE and PubMed literature search using keywords \u201cmultidrug resistant organisms\u201d, \u201cventilator-associated pneumonia\u201d and \u201cdecision making\u201d, \u201ctreatment\u201d or \u201cstrategy\u201d was used to identify 329 references as background for this review. Lack of universally accepted diagnostic criteria for ventilator-associated pneumonia, or ventilator-associated tracheobronchitis complicates treatment decisions. Consideration of the clinical context including signs of respiratory infection or deterioration in respiratory or other organ function is essential. The higher the quality of respiratory specimens or the presence of bacteremia would suggest the MDRO is a true pathogen, rather than colonization, and warrants antimicrobial therapy. A patient with higher severity of illness has lower safety margins and may require initiation of antimicrobial therapy until an alternative diagnosis is established. A structured approach to the decision to treat with antimicrobial therapy is proposed.<\/jats:p>","DOI":"10.3390\/antibiotics11040452","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:27:51Z","timestamp":1648416471000},"page":"452","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Narrative Review on the Approach to Antimicrobial Use in Ventilated Patients with Multidrug Resistant Organisms in Respiratory Samples\u2014To Treat or Not to Treat? That Is the Question"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-7344","authenticated-orcid":false,"given":"Lowell","family":"Ling","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai-Tat","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5965-9876","authenticated-orcid":false,"given":"Jeffrey","family":"Lipman","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital and Jamieson Trauma Institute, The University of Queensland, Brisbane, QLD 4029, Australia"},{"name":"Nimes University Hospital, University of Montpelier, 30900 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5823-3435","authenticated-orcid":false,"given":"Gavin Matthew","family":"Joynt","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1086\/501795","article-title":"Nosocomial infections in combined medical-surgical intensive care units in the United States","volume":"21","author":"Richards","year":"2000","journal-title":"Infect. 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