Nosocomial pneumonia.
OBJECTIVE
This review describes the most recent advances in the management and prevention of nosocomial pneumonia. The new ATS guidelines in particular are most likely to affect clinical practice outside the USA.


RESULTS
The problem of multidrug-resistant bacteria causing nosocomial pneumonia seems to be increasing. This is particularly true for methicillin-resistant Staphylococcus aureus. While the diagnosis of ventilator associated pneumonia remains a conflictive issue, serial tracheobronchial aspirates may improve the selection of adequate antimicrobial treatment. Combined beta-lactam and aminoglycoside therapy is inferior to beta-lactam monotherapy, both in terms of clinical outcome and in the prevention of resistance during treatment; in addition, it carries an increased risk of nephrotoxicity.


CONCLUSIONS
The updated ATS guidelines will considerably impact clinical approaches to nosocomial and healthcare-related pneumonia. Serial tracheobronchial aspirates can be used to guide selection of antimicrobial treatment in ventilator associated pneumonia. The combination of beta-lactams and aminoglycosides is likely to be abandoned in the future. New potent treatment options for pneumonia due to nonfermenters are urgently needed.
Ostendorf
Uwe
U
Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Bochum, Germany.
Ewig
Santiago
S
Torres
Antoni
A
D000617:Aminoglycosides / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*; D047090:beta-Lactams / Q000627:therapeutic use
D000617:Aminoglycosides; D047090:beta-Lactams