The role of surveillance cultures in guiding ventilator-associated pneumonia therapy.
OBJECTIVE
Ventilator-associated pneumonia (VAP) is the most frequent cause of death among the nosocomial infections acquired in the ICU. Routine surveillance endotracheal aspirate (ETA) cultures in patients on mechanical ventilation have been proposed to predict the cause of VAP. Our aim is to review the available experience regarding the role of surveillance ETA cultures in guiding VAP antimicrobial therapy.


RESULTS
Microorganisms arrive in the lower respiratory tract by aspiration from the oropharynx or gastric reflux, extension from a contiguous infection, air contamination or by hematogenous seeding. Bacterial colonization of the airway leads to the development of VAP and may result from the aspiration of oropharyngeal or gastric secretions. Recent studies have suggested that surveillance cultures could provide a rationale for prescribing appropriate antibiotics, while waiting for culture results, in up to 95% of patients in whom VAP is ultimately diagnosed by bronchoalveolar lavage fluid culture. However, some authors observed that guiding therapy with those routine surveillance cultures leads to unacceptably low coverage of the pathogens producing VAP.


CONCLUSIONS
This article describes the evidence supporting the use of routine ETA cultures to prescribe appropriate initial empirical therapy compared with the current practice dictated by guidelines.
Pulmonary Diseases Division, Department of Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
Carlos M
CM
Luna
Ignacio
I
Bledel
Alejandro
A
Raimondi
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001419:Bacteria / Q000302:isolation & purification*; D001431:Bacteriological Techniques / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D014132:Trachea / Q000382:microbiology*
D000900:Anti-Bacterial Agents