Hospital-acquired pneumonia: diagnostic strategies: lessons from clinical trials

Appropriate antimicrobial treatment of patients with ventilator-associated pneumonia (VAP) significantly improves outcome. Use of empiric broad-spectrum antibiotics in patients without bacterial lung infection is potentially harmful, because it facilitates colonization and superinfection with multiresistant organisms. Using bronchoscopic techniques to obtain protected specimen brush or bronchoalveolar lavage specimens for quantitative cultures from the affected area in the lung permits physicians to devise a strategy accurate for identifying patients with VAP, selecting rapidly appropriate initial antimicrobial therapy, adjusting therapy, and withholding antibiotics from patients without VAP. When fiberoptic bronchoscopy is not available, clinical strategy with the use of short-course antibiotics or quantitative cultures of specimens obtained with simplified nonbronchoscopic diagnostic procedures are possible alternatives.