Eurasian Journal of Chemical, Medicinal and Petroleum Research

Abstract Introduction: Ventilator-associated pneumonia (VAP) remains a major intensive care unit complication, contributing to prolonged mechanical ventilation, antimicrobial overuse, multidrug resistance, and increased mortality. Despite advances in prevention and conventional antibiotics, treatment failure remains frequent. This study aims to review and highlight novel therapeutic strategies for improving clinical outcomes in patients with VAP.

Material and methods: This systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, Web of Science, EMBASE, Google Scholar, SID, and Magiran were systematically searched using keywords including “ventilator-associated pneumonia,” “VAP,” “novel therapeutic strategies,” “bacteriophage therapy,” “immunotherapy,” “monoclonal antibodies,” “inhaled antibiotics,” and “multidrug-resistant pathogens,” combined with Boolean operators to identify eligible studies on emerging VAP treatments.

Results: Synthesis of six eligible studies (n = 6; RCTs: 33.3%, cohort designs: 33.3%) demonstrated that novel VAP strategies enhanced microbiological clearance and clinical cure against MDR/XDR pathogens. Rapid molecular diagnostics reduced time to targeted therapy, whereas resistance-guided regimens improved treatment adequacy. Overall methodology exhibited low risk of bias across key Cochrane domains (>80% domain adequacy), validating the clinical reliability of these precision-guided and adjunctive therapeutic modalities.

Conclusion: Novel therapeutic strategies, including inhaled antibiotics, bacteriophages, monoclonal antibodies, and rapid diagnostic-guided regimens, offer effective alternatives for managing multidrug-resistant VAP. Integrating these precision-driven and adjunctive modalities optimizes targeted pathogen clearance, mitigates systemic toxicity, and improves clinical management in intensive care settings. Future large-scale clinical trials remain essential to standardize protocols and validate long-term clinical efficacy.

Abstract Introduction: Femoral fracture surgery in elderly patients is frequently followed by substantial acute postoperative pain, which may be influenced not only by surgical trauma but also by systemic inflammatory and immune responses. Because the Systemic Immune-Inflammation Index may reflect this biological susceptibility, the present study aimed to pathologically assess its association with the severity of acute postoperative pain after femoral fracture surgery.

Material and methods: This descriptive cross-sectional study was conducted at Shahid Madani Hospital, Tabriz, on 93 elderly patients selected by convenience sampling, with sample size estimated using Cochran’s formula. Demographic, clinical, laboratory, surgical, and postoperative pain data were collected. The Systemic Immune-Inflammation Index was calculated from preoperative platelet, neutrophil, and lymphocyte counts, and its association with acute postoperative pain severity was statistically evaluated.

Results: Patients with severe postoperative pain had markedly higher preoperative SII than those with moderate or mild pain (1801.2±789.6 vs 1280.5±542.7 and 850.2±386.4; P<0.001), along with higher inflammatory markers, lower hemoglobin and albumin, longer operations, greater blood loss, more opioid use, delayed mobilization, and longer hospitalization (all P<0.05). SII correlated with pain intensity (highest 24-hour NRS: r=0.574, P<0.001) and independently predicted severe pain (OR=2.86, 95% CI 1.54-5.31), with good accuracy (AUC=0.812).

Conclusion: Preoperative SII appears to be a clinically useful biomarker for identifying patients at increased risk of severe acute postoperative pain. Its independent association with pain severity and acceptable diagnostic performance suggest that SII may support early perioperative risk stratification and help guide individualized analgesic planning, particularly in patients with an elevated inflammatory burden before surgery.