ABSTRACT
The diagnosis of ventilator-associated pneumonia (VAP) is an unsettled and controversial area, with no agreement about whether the decision to start antibiotic therapy, in the setting of suspected infection, should be guided by clinical criteria (the ‘‘clinical approach’’) or by microbiologic data from quantitative samples of lower airway secretions (the ‘‘bacteriologic approach’’) (1,2). This controversy exists because the clinical definition of pneumonia although sensitive, is not very specific, and many patients with the clinical findings of VAP may have a noninfectious etiology for their findings of a new lung infiltrate accompanied by fever, purulent sputum, and leukocytosis. In fact, some studies have reported that as many as two-thirds of all patients with the clinical diagnosis of VAP may not meet microbiologic criteria for infection (3).
