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Epidemiology of Ventilator-Associated Pneumonia*

Donald E. Craven, MD, FCCP
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*From the Clinical AIDS Program, Boston City Hospital, Boston, MA.



Chest. 2000;117(4_suppl_2):186S-187S. doi:10.1378/chest.117.4_suppl_2.186S
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Extract

Despite remarkable progress in our understanding of ventilator-associated pneumonia (VAP) over the past decade, controversy persists over the optimal method of diagnosis. Accurate diagnosis is critical for identifying specific etiologic agents, for implementing appropriate therapy, and for prevention strategies.

Currently, there is no well-accepted “gold standard” for diagnosis, but, rather, there is a variety of diagnostic procedures with variable sensitivity and specificity.2,3 Bronchoscopy with the use of BAL or a protected-specimen brush has greater specificity than a clinical diagnosis,2,3 which has been used more commonly over the past decade. Nonbronchoscopic methods, such as blinded BAL or quantitative endotracheal aspiration, with and without the clinical pulmonary infection score, are more specific than clinical diagnosis.2–4 Regardless of the diagnostic method used, the American Thoracic Society Consensus Group suggested empirical initial therapy, based on the severity of the patient’s disease and the stage of onset, using antibiotics to cover special pathogens in patients with specific risk factors.5

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