Sputum nosocomial pneumonia

Expectorated sputum and tracheal aspirate specimens obtained by direct suctioning through the endotracheal tube in mechanically ventilated patients are easily obtained but notoriously nonspecific in the diagnosis of nosocomial pneumonia. Bartlett et al. prospectively evaluated cultures of expectorated sputum in 67 patients with nosocomial pneumonia whose final diagnosis was based on bacterial studies from uncontamined specimens (blood, transtracheal... 

Once the diagnosis of nosocomial pneumonia has been established, several important factors must be considered before a rational empirical antimicrobial regimen can be chosen. These include severity of illness and comorbid conditions of the patient, prior antibiotic use, early versus late onset of infection, results of the sputum Gram s stain, and the resident flora profile of the institution, particularly in the intensive care unit (Table 1). Empirical antimicrobial therapy for nosocomial pneumonia in a ventilated patient with renal failure in whom multiple intra-abdominal abscesses develop following colon resection is very different from the patient who aspirates following an otherwise uncomplicated cholecystectomy. 

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