Diagnostic strategies for nosocomial pneumonia

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: This review describes advances in clinical and microbiological modalities for diagnosis of nosocomial pneumonia and the role of biological markers. RECENT FINDINGS: Serial assessments with the clinical pulmonary infection score identifies nonsurvivors and allows discontinuation of antibiotics when there is low suspicion of pneumonia. Studies evaluating its clinical utility show mixed results. A meta-analysis revealed that an invasive approach does not affect mortality but reduces costs, antibiotic exposure, and multidrug resistance. In contrast to these findings, a recent trial comparing nonquantitative endotracheal aspirate and quantitative bronchoalveolar lavage cultures showed similar clinical outcomes and antibiotic utilization. The role of quantitative endotracheal aspirate for diagnosis of pneumonia not related to mechanical ventilation was recently evaluated. Procalcitonin and soluble triggering receptor expressed on myeloid cells-1 aid in diagnosis, identify sepsis related to ventilator-associated pneumonia and patients with worst outcomes. SUMMARY: The diagnostic modality chosen depends on availability, personnel experience, and the patient's clinical status. Recent guidelines support the use of quantitative cultures in an integrated clinical and microbiological algorithm. The decision to adjust antibiotics involves clinical reassessment and interpretation of culture results. Biological markers have a potential role as screening and prognostic tools.

Original languageEnglish (US)
Pages (from-to)186-191
Number of pages6
JournalCurrent Opinion in Pulmonary Medicine
Volume13
Issue number3
DOIs
StatePublished - May 2007
Externally publishedYes

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Pneumonia
Anti-Bacterial Agents
Biomarkers
Ventilator-Associated Pneumonia
Calcitonin
Multiple Drug Resistance
Bronchoalveolar Lavage
Myeloid Cells
Microbial Drug Resistance
Artificial Respiration
Meta-Analysis
Sepsis
Guidelines
Costs and Cost Analysis
Lung
Mortality
Infection

Keywords

  • Clinical pneumonia infection score
  • Hospital-acquired pneumonia
  • Procalcitonin
  • sTREM-1
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Diagnostic strategies for nosocomial pneumonia. / Soto, Graciela J.

In: Current Opinion in Pulmonary Medicine, Vol. 13, No. 3, 05.2007, p. 186-191.

Research output: Contribution to journalArticle

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