investigators have studied the role of bronchoscopy in evaluating and
managing patients with nosocomial pneumonia who are not responding to
initial antibiotic therapy. This discussion examines whether the
information provided by bronchoscopy has value in this setting, as well
as whether the concept of using bronchoscopy for the nonresponding
patient is a logical one.
Importantly, serial bronchoscopy is generally performed while the
patient is receiving antibiotic therapy. Such therapy can reduce the
yield and accuracy of quantitative cultures of respiratory secretions.
The presumption for using serial cultures in the nonresponding patient
is that bacteria are present that have not been eliminated by currently
administered antibiotics. Moreover, these organisms can be identified
early enough so that changes in therapy will improve the outcome in