Nosocomial pneumonia

Nosocomial pneumonia, and specifically ventilator-associated pneumonia (VAP), is a major cause of morbidity and mortality in the intensive care unit. There are a number of evolving practices to reduce rates of VAP including minimizing intubation time, reducing risk of aspiration of oropharyngeal secretions, and in some settings, using antibiotics to selective decontaminate the oropharynx and proximal gastrointestinal tract. When suspected, VAP is best diagnosed with cultures from endotracheal tube aspirates or bronchoscopy specimen if the patient is undergoing bronchoscopy for therapeutic purposes. Broad-spectrum empiric therapy should be started immediately with consideration of local resistance patterns and then deescalated as culture results return to normal.