Controversies on diagnosis and prevention of ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) is the most frequent infection among intensive care patients. There is a great deal of controversy about the met hod for diagnosis and prevention of this infection. VAP is usually diagnose d on a combination of clinical, microbiological, and radiographic criteria. Although these criteria have a high sensitivity, specificity is low, resul ting in unnecessary antibiotic use in many patients. Bronchoscopic techniqu es, such as protected specimen brush and bronchaolveolar lavage, in combina tion with quantitative culture techniques, do have a higher specificity. ho wever, whether implementation of these techniques influences patient care a nd to what cost, remains to be determined. Prevention of VAP relies on basi c infection control practices. Many specific strategies interfering with co lonization routes have been studied. so far, only the use of tropical nonab sorbable antibodies, either of the whole digestive tract or the oropharynx only, consistently reduced the incidence of VAP. however, the effects on pa tient survival were disappointing and the possibility of selection of antib iotic-resistant bacteria limit the widespread use of these strategies. (C) 1999 Elsevier Science Inc.