Excessive antimicrobial usage causes measurable harm to patients with suspected ventilator-associated pneumonia

Excerpt

Controversies regarding the management, optimal use of antibiotic therapy, and diagnostic methodology have spawned an accumulating body of literature attempting to address these issues. Over 300 studies have been published in peer-review journals in the past 8 years dealing with management of ventilator-associated pneumonia. A frustrating dilemma, nevertheless, is that there is no consensus on even the precise definition of ventilator-associated pneumonia. The greatest uncertainty deals with the necessity for invasive diagnostic methods, specifically quantitative cultures from the lung by bronchoalveolar lavage (BAL) or protected specimen brush (PSB). We do not wish to become embroiled in this controversy; however, it must be conceded that despite numerous labor-intensive and rigorous trials by respected investigators, no consensus exists on the necessity of such procedures, and routine use of these procedures have not widely been adopted in intensive care units. …