title: Diagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach?
abstract: OBJECTIVE
  Diagnosis of ventilator-associated pneumonia remains controversial. Different approaches are advocated, but none has yet demonstrated superiority. Diagnosis based on clinical data and aetiological diagnosis of ventilator-associated pneumonia episodes are two concepts that should be combined in an integrative evaluation for ventilator-associated pneumonia. Recent findings in diagnosis are reviewed here.
  
  
  RESULTS
  Studies of various diagnostic strategies have been conducted to evaluate whether they influence outcome. Strategies include use of biomarkers (e.g. C-reactive protein and procalcitonin) and use of clinical scores to render the diagnostic process more objective. The appropriateness of the available aetiological diagnostic techniques and their reliability in the absence of a 'gold standard' for diagnosis were also recently addressed. It remains controversial whether type of culture (quantitative or nonquantitative) or sampling method (invasive or noninvasive) influences aetiological diagnosis or outcomes in ventilator-associated pneumonia. It is unlikely that any single approach is the optimal diagnostic assessment whenever ventilator-associated pneumonia is suspected.
  
  
  CONCLUSIONS
  Microbiological data should always be used in association with clinical data when assessing patients with suspected ventilator-associated pneumonia. Integration of these data might be the most simple and effective strategy for diagnosing ventilator-associated pneumonia.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital, University Rovira & Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain.
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000382:microbiology; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000382:microbiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein