NOSOCOMIAL PNEUMONIA - TRYING TO MAKE SENSE OF THE LITERATURE

It seems clear that aggressive treatment of nosocomial pneumonia is ne eded and may be beneficial. How is antibiotic intervention best used? Information suggests that a substantial number of patients suspected o f having nosocomial pneumonia do not actually have it. Other data sugg est that indiscriminate use of antibiotics predisposes patients to inf ection and, even more important, to infection caused by more virulent and resistant organisms, which leads to higher mortality. Without a re adily available and reliable test for nosocomial pneumonia, we must do our best with the methods available to us to establish a diagnosis an d designate appropriate treatment for each patient. When reviewing lit erature pertaining to nosocomial pneumonia, one must continue to make an effort to determine what the data actually say and whether an autho r's conclusions from that data are valid. One must avoid the Bellman's error in Lewis Carroll's The Hunting of the Snark: ''What I say to yo u three times is true....'' The frequent repetition of a conclusion by many voices does not necessarily guarantee its validity.