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Identifying the Causative Organism in Patients With Ventilator-Associated Pneumonia-Reply FREE

Fabienne Bregeon, MD; Laurent Papazian, MD
JAMA. 1997;278(1):25-25. doi:10.1001/jama.1997.03550010039034
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In Reply.  —We agree with Drs Marik and Varon that clinical diagnosis alone is not sufficient to draw conclusions regarding the diagnosis of VAP and that a microbiological diagnosis facilitates appropriate antimicrobial therapy. For these reasons, in our analysis, all of the patients were positive for at least 1 microbiological sampling technique; moreover, in 74% of the cases at least 3 techniques were positive in culture. Nevertheless, this presents a good opportunity to state that the unfair criticism the clinical examination has received is no doubt because of poor interpretation of the studies on this subject. Indeed, in the study by Andrews et al,1 the clinical diagnosis was accurate in 71% of the cases. In the study by Fagon et al,2 when there was complete agreement by the medical staff, the clinical diagnosis was correct in 90% of the cases. In the study conducted by our team,3 the clinical

REFERENCES

Andrews CP, Coalson JJ, Smith JD, Johanson WG.  Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury . Chest . 1981;;80:254-258.
Fagon J-Y, Chastre J, Hance AJ, Domart Y, Trouillet J-L, Gibert C.  Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia . Chest . 1993;;103:547-553.
Papazian L, Thomas P, Garbe L, et al.  Bronchoscopic or blind bronchial sampling techniques for the diagnosis of ventilator-associated pneumonia . Am J Respir Crit Care Med . 1995;;152:1982-1991.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM.  Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic'blind'bronchoalveolar lavage fluid . Am Rev Respir Dis . 1991;;143:1121-1129.
Marquette CH, Copin M-C, Wallet F, et al.  Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard . Am Rev Respir Dis . 1995;;151:1878-1880.

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Andrews CP, Coalson JJ, Smith JD, Johanson WG.  Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury . Chest . 1981;;80:254-258.
Fagon J-Y, Chastre J, Hance AJ, Domart Y, Trouillet J-L, Gibert C.  Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia . Chest . 1993;;103:547-553.
Papazian L, Thomas P, Garbe L, et al.  Bronchoscopic or blind bronchial sampling techniques for the diagnosis of ventilator-associated pneumonia . Am J Respir Crit Care Med . 1995;;152:1982-1991.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM.  Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic'blind'bronchoalveolar lavage fluid . Am Rev Respir Dis . 1991;;143:1121-1129.
Marquette CH, Copin M-C, Wallet F, et al.  Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard . Am Rev Respir Dis . 1995;;151:1878-1880.
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