Guidelines for treatment of hospital-acquired pneumonia

In the past decade, much information has been gained on the diagnostic and therapeutic strategies in patients suspected of having hospital-acquired pneumonia. The key to an effective therapeutic approach is the diagnostic strategy used, and timely administration of appropriate antibiotic therapy. Many patients, but not all, need early appropriate empiric therapy. This decision and the selection of the initial regimen is based on local epidemiological and surveillance data, the clinical presentation, and the recent history of the individual patient; direct examination of reliable respiratory tract samples can provide a valuable help, but cannot be relied on solely. Whenever possible, the timely performance of such samples (i.e., before instituting therapy) is of paramount importance because this will bear heavily on their interpretation and the conduct of subsequent and definitive therapy. Hospitals are now plagued with infection caused by increasingly multidrug-resistant organisms; this is especially the case in intensive care units (ICUs), where nosocomial respiratory tract infection is the primary reason for prescribing antibiotics. Although many questions remain unanswered regarding the optimal choices and duration of therapy, reversing this trend will require continuous and prolonged efforts to strictly adhere to a rigorous approach for antibiotic prescribing in nosocomial respiratory tract infection.