Bronchoalveolar lavage for VAP diagnosis: patients must be sampled before any change of antimicrobial therapy

Excerpt

Appropriate antibiotics may improve survival in patients with bacterial pneumonia. However, the use of empirical broad-spectrum antibiotics in patients without infection is potentially harmful, facilitating colonization and superinfection with multiresistant micro-organisms [1]. In order to achieve these goals most authors recommend starting broad-spectrum antibiotics immediately after a bacteriological sample (plus one or two blood cultures) has been performed [1‐5]. This strategy permits a rapid stop of the antibiotic in the event of negative findings and a subsequent de-escalation according to the micro-organisms recovered from bacteriological culture [2, 5, 6]. Unfortunately, bacteriology is not available at any time in most ICUs. Consequently one major question is the reliability of bacteriological samples performed after the institution of new antibiotics in patients with recent pulmonary infiltrates compatible with nosocomial pneumonia. The impact of previous antimicrobials used on this strategy is a key matter of concern. …