RESPIRATORY INFECTIONS: Edited by Michael S. NiedermanThe role of surveillance cultures in guiding ventilator-associated pneumonia therapyLuna, Carlos M.; Bledel, Ignacio; Raimondi, AlejandroAuthor Information Pulmonary Diseases Division, Department of Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina Correspondence to Carlos M. Luna, Arenales 2557, Piso 1, Dto A, Buenos Aires (1425), Argentina. Tel: +54 9 11 5756 1535; fax: +54 11 5950 8937; e-mail: [email protected] Current Opinion in Infectious Diseases: April 2014 - Volume 27 - Issue 2 - p 184-193 doi: 10.1097/QCO.0000000000000042 Buy Metrics Abstract Purpose of review Ventilator-associated pneumonia (VAP) is the most frequent cause of death among the nosocomial infections acquired in the ICU. Routine surveillance endotracheal aspirate (ETA) cultures in patients on mechanical ventilation have been proposed to predict the cause of VAP. Our aim is to review the available experience regarding the role of surveillance ETA cultures in guiding VAP antimicrobial therapy. Recent findings Microorganisms arrive in the lower respiratory tract by aspiration from the oropharynx or gastric reflux, extension from a contiguous infection, air contamination or by hematogenous seeding. Bacterial colonization of the airway leads to the development of VAP and may result from the aspiration of oropharyngeal or gastric secretions. Recent studies have suggested that surveillance cultures could provide a rationale for prescribing appropriate antibiotics, while waiting for culture results, in up to 95% of patients in whom VAP is ultimately diagnosed by bronchoalveolar lavage fluid culture. However, some authors observed that guiding therapy with those routine surveillance cultures leads to unacceptably low coverage of the pathogens producing VAP. Summary This article describes the evidence supporting the use of routine ETA cultures to prescribe appropriate initial empirical therapy compared with the current practice dictated by guidelines. © 2014 Lippincott Williams & Wilkins, Inc.