Nosocomial pneumonia.

Despite many advances in infection control measures, nosocomial pneumonia remains a frequent complication in ventilator-dependent patients cared for in the intensive care unit. During the past year in review, many important articles have been published dealing with critical issues for the optimal management of such patients. Nasal cannulation for endotracheal and gastric intubation has been recognized as a major risk factor for nosocomial infection in patients requiring mechanical ventilation. Although selective digestive decontamination remains highly controversial due to the risk of selecting for multi-resistant microorganisms, the potential benefit of using sucralfate for prevention of late onset pneumonia appears promising. There has been relatively little progress made regarding the optimal management strategy to use in patients with suspected pneumonia, except that protected specimen brush and bronchoalveolar lavage techniques were both qualitatively and quantitatively demonstrated to reliably identify microorganisms present in the lung, even when the infection develops as a superinfection in a patient already receiving antimicrobial therapy. Antibiotic treatment of nosocomial pneumonia remains a complex undertaking, and further trials will be ultimately needed to clarify in which circumstances monotherapy can be safely used.