title: Surveillance cultures in healthcare-associated pneumonia: sense or nonsense?
abstract: OBJECTIVE
  This review explores the usefulness of surveillance cultures in healthcare-associated pneumonia (HCAP).
  
  
  RESULTS
  The definition of HCAP is controversial. Causative micro-organisms of HCAP resemble those found in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Some types of surveillance cultures have proven useful in hospitalized patients. Whereas numerous studies have investigated the role of surveillance cultures in VAP, one may wonder whether surveillance culture implementation should belong in HCAP management guidelines.
  
  
  CONCLUSIONS
  Studies exploring the usefulness of obtaining surveillance cultures in VAP are numerous, but are mostly retrospective, observational and/or quasi-experimental in nature. Surveillance cultures may be useful for antibiotic guidance, but positive predictive value and specificity of surveillance cultures are low, obviously negatively impacting on cost effectiveness, especially in the large population at risk for HCAP. On the other hand, multidrug-resistance is increasing and surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in ICU-admitted patients appeared useful and cost-effective. Furthermore, surveillance cultures for the presence of multidrug-resistant Gram-negative bacilli might be useful for antibiotic guidance. Currently, neither community-acquired pneumonia, HCAP, HAP nor VAP guidelines incorporate surveillance cultures. In the future, surveillance cultures in populations at risk for HCAP may be able to differentiate HCAP from other kinds of pneumonia and authorize its reason for existence.
authors.affiliation: aDepartment of Intensive Care Medicine, Maastricht University Medical Center bDepartment of Medical Microbiology, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Johannes B J
authors.initials: JB
authors.lastname: Scholte
authors.forename: Walther N K A
authors.initials: WN
authors.lastname: van Mook
authors.forename: Catharina F M
authors.initials: CF
authors.lastname: Linssen
mesh_terms: D003428:Cross Infection / Q000175:diagnosis* / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D018571:Sentinel Surveillance