Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies: A consensus statement

American Journal of Respiratory and Critical Care Medicine

Volumn 153, Issue 5, 1996, Pages 1711-1725

  Campbell Jr , G D ^a   Niederman, M S ^a   Broughton, W A ^a   Craven, D E ^a   Fein, A M ^a   Fink, M P ^a   Gleeson, K ^a   Hornick, D B ^a   Lynch III, J P ^a   Mandell, L A ^a   Mason, C M ^a   Torres, A ^a   Wunderink, R G ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

AMINOGLYCOSIDE ANTIBIOTIC AGENT; ANTACID AGENT; ANTIBIOTIC AGENT; AZLOCILLIN; AZTREONAM; BETA LACTAM ANTIBIOTIC; BETA LACTAMASE INHIBITOR; BIOLOGICAL RESPONSE MODIFIER; CARBAPENEM; CEFOPERAZONE; CEFTAZIDIME; CEPHALOSPORIN DERIVATIVE; CIPROFLOXACIN; CLINDAMYCIN; ERYTHROMYCIN; GAMMA INTERFERON; GRANULOCYTE COLONY STIMULATING FACTOR; HISTAMINE H2 RECEPTOR ANTAGONIST; IMIPENEM; METRONIDAZOLE; MEZLOCILLIN; PENICILLIN DERIVATIVE; PENICILLIN G; PIPERACILLIN; QUINOLINE DERIVED ANTIINFECTIVE AGENT; RIFAMPICIN; SUCRALFATE; VANCOMYCIN;

ANTIBIOTIC THERAPY; BACTERIAL COLONIZATION; BACTERIAL PNEUMONIA; CLINICAL TRIAL; HAND WASHING; HOSPITAL INFECTION; HUMAN; IMMUNOPROPHYLAXIS; INFECTION PREVENTION; INTRAVENOUS DRUG ADMINISTRATION; META ANALYSIS; NUTRITIONAL SUPPORT; ORAL DRUG ADMINISTRATION; PRIORITY JOURNAL; REVIEW; RISK FACTOR; TREATMENT OUTCOME;

EID: 9244228530     PISSN: 1073449X     EISSN: None     Source Type: Journal    
DOI: 10.1164/ajrccm.153.5.8630626     Document Type: Review

References (111)

1. Craven, D E., K. A. Steger, and T. W. Barber. 1991. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990's Am. J. Med. 91(3B):44S-53S.
2. Mandell, L. A., T. J. Marrie, M. S. Niederman, and the Canadian Hospital Acquired Pneumonia Consensus Conference Group. 1993. Initial antimicrobial treatment of hospital acquired pneumonia in adults: a conference report. Can. J. Infect. Dis. 4:317-321.
3. Craven, D. E., and M. R. Driks. 1987. Pneumonia in the intubated patient. Semin. Respir. Infect. 2:20-33.
4. Torres, A., R. Aznar, J. M. Gatell, P. Jimenez, J. Gonzalez, A. Ferrer, R. Celis, and R. Rodriguez-Roisin. 1990. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am. Rev. Respir. Dis. 142:523-528.
5. Cells, R., A. Torres, J. M. Gatell, M. Almela, R. Rodriguez-Roisin, and A. Agusti-Vidal. 1988. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest 93:318-324.
6. Gross, P. A., and C. Van Antwerpen. 1983. Nosocomial infections and hospital deaths: a case-control study. Am. J. Med. 75:658-662.
7. Gross, P. A., H. C. New, P. Aswapokee, C. Van Antwerpen, and N. Aswapokee. 1980. Deaths from nosocomial infections: experience in a university hospital and a community hospital. Am. J. Med. 68:219-223.
8. Fagon, J. Y., J. Chastre, Y. Domart, J. L. Trouillet, J. Pierre, C. Carne, and C. Gibert. 1989. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Am. Rev. Respir. Dis. 139: 877-884.
9. Fagon, J. Y., J. Chastre, A. Hance, P. Montravers, A. Novara, and C. Gibert. 1993. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am. J. Med. 94:281-288.
10. Leu, H. S., D. L. Kaiser, M. Mori, R. F. Woolson, and R. P. Wenzel. 1989. Hospital-acquired pneumonia attributable mortality and morbidity. Am. J. Epidemiol. 129:1258-1267.
11. Bryan, C. S., and K. L. Reynolds. 1984. Bacteremic nosocomial pneumonia. Am. Rev. Respir. Dis. 129:668-671.
12. Niederman, M. S., A. Torres, and W. Summer. 1994. Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia. Am. J. Respir. Crit. Care Med. 150:565-569.
13. Chastre, J., and J. Y. Fagon. 1994. Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia. Am. J. Respir. Crit. Care Med. 150:570-574.
14. Niederman, M. S., J. B. Bass, Jr., G. D. Campbell, A. M. Fein, R. F. Grossman, L. A. Mandell, T. J. Marrie, G. A. Sarosi, A. Torres, and V. L. Yu. 1993. Guidelines for the intiial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am. Rev. Respir. Dis. 148: 1418-1426.
15. Johanson, W. G., A. K. Pierce, J. P. Sanford, and G. D. Thomas. 1972. Nosocomial tespiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract. Ann. Intern. Med. 77:701-706.
16. Huxley, E. J., J. Viroslav, W. R. Gray, and A. K. Pierce. 1978. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am. J. Med. 64:564-568.
17. Johanson, W. G., A. K. Pierce, and J. P. Sanford. 1969. Changing pharyngeal bacterial flora of hospitalized patients: emergence of gram-negative bacilli. N. Engl. J. Med. 281:1137-1140.
18. Holladay, R. C., and G. D. Campbell, Jr. 1995. Nosocomial viral pneumonia in the intensive care unit. Clin. Chest Med. 16:121-133.
19. Niederman, M. S., R. Mantovani, P. Schoch, J. Papas, and A. M. Fein. 1989. Patterns and routes of tracheobronchial colonization in mechanically ventilated patients: the role of nutritional status in colonization of the lower airway by Pseudomonas species. Chest 95:155-161.
20. Craven, D. E., L. M. Kunches, V. Kilinsky, D. A. Lictenberg, B. J. Make, and W. R. McCabe. 1986. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am. Rev. Respir. Dis. 133:792-796.
21. Gyetko, M. R., and G. B. Toews. 1993. Immunology of the aging lung. Clin. Chest Med. 14:379-391.
22. Maki, D. G., 1978. Control of colonization and transmission of pathogenic bacteria in the hospital. Ann. Intern. Med. 89: 777-780.
23. Weinstein, R. A. 1991. Epidemiology and control of nosocomial infections in adult intensive care units. Am. J. Med. 91(3B):179S-184S.
24. du Moulin, G. C., J. Hedley-Whyte, D. G. Paterson, and A. Lisbon. 1982. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway. Lancet 1: 242-245.
25. Driks, M. R., D. E. Craven, B. R. Celli, M. Manning, M. A. Burke, G. M. Garvin, L. M. Kunches, H. W. Farber, S. A. Wedel, and W. R. McCabe. 1987. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N. Engl. J. Med. 317: 1376-1382.
26. Torres, A., J. Serra-Batlles, E. Ros, C. Piera, J. Puig de la Bellacasa, A. Cobos, F. Lomena, and R. Rodriguez-Roisin. 1992. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann. Intern. Med. 116:540-543.
27. Jacobs, S., R. W. Chang, B. Lee, and F. W. Bartlett. 1990. Continuous enterai feeding: a major cause of pneumonia among ventilated intensive care unit patients. Parenteral Nutrition 14:353-356.
28. Inglis, T. J., M. R. Millar, G. Jones, and D. A. Robinson. 1989. Tracheal tube biofilm as a source of bacterial colonization of the lung. J. Clin. Microbiol. 27:2014-2018.
29. Rouby, J. J., E. Martin De Lassale, P. Poete, M. H. Nicolas, L. Bodin, V. Jarlier, Y. Le Charpentier, J. Grosset, and P. Viars. 1992. Nosocomial bronchopneumonia in the critically ill: histologic and bacteriologic aspects. Am. Rev. Respir. Dis. 146:1059-1066.
30. Horan, T. C., J. W. White, W. R. Jarvis, T. G. Emori, D. H. Culver, V. P. Munn, C. Thornsberry, D. R. Olson, and J. M. Hughes. 1986. Nosocomial infection surveillance. MMWR 35:17SS-29SS.
31. Schleupner, C. J., and D. K. Cobb. 1992. A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital. Infect. Control Hosp. Epidemiol. 13:515-525.
32. Bartlett, J. G., P. O'Keefe, F. P. Tally, T. J. Louie, and S. L. Gorbach. 1986. Bacteriology of hospital-acquired pneumonia. Arch. Intern. Med. 146:868-871.
33. Torres, A., J. P. Puig de la Bellacasa, A. Xaubet, J. Gonzalez, R. Rodriguez-Roisin, M. T. Jimenez de Anta, and A. Agusti-Vidal. 1989. Diagnostic value of quantitatiave cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am. Rev. Respir. Dis. 140:306-310.
34. Fagon, J. Y., J. Chastre, A. J. Hance, M. Guiguet, J. L. Trouillet, Y. Domart, J. Pierre, and C. Gibert. 1988. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am. Rev. Respir. Dis. 138:110-116.
35. Prod'hom, G., P. Leuenberger, J. Koerfer, A. Blum, R. Chiolero, M. D. Schaller, C. Perret, O. Spinnler, J. Blondel, and H. Siegrist. 1994. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer: a randomized controlled trial. Ann. Intern. Med. 120:653-662.
36. Mier, L., D. Dreyfuss, B. Darchy, J. J. Lanore, K. Djedaini, P. Weber, P. Brun, and F. Coste. 1993. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 19:279-274.
37. Niederman, M. S., D. E. Craven, A. M. Fein, and D. E. Schultz. 1990. Pneumonia in the critically ill hospitalized patient. Chest 97:170-181.
38. Rello, J., E. Quintana, V. Ausina, C. Puzo, A. Net, and G. Prats. 1990. Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients. Am. Rev. Respir. Dis. 142:1320-1324.
39. Rello, J., A. Torres, M. Ricart, J. Valles, J. Gonzales, A. Artigas, and R. Rodriguez-Roisin. 1994. Ventilator-associated pneumonia by Streptococcus aureus: comparison of methicillin-resistant and methicillin-sensitive episodes. Am. J. Respir. Crit. Care Med. 150:1545-1549.
40. Rello, J., V. Ausina, M. Ricart, J. Castella, and G. Prats. 1993. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 104:1230-1235.
41. Niederman, M. S. 1990. Gram-negative colonization of the respiratory tract: pathogenesis and clinical consequences. Semin. Respir. Infect. 5:173-181.
42. Carratala, J., F. Gudiol, R. Pallares, J. Dorca, R. Verdaguer, J. Ariza, and F. Manresa. 1994. Risk factors for nosocomial Legionella pneumophila pneumonia. Am. J. Respir. Crit. Care Med. 149: 625-629.
43. Rodrigues, J., M. S. Niederman, A. M. Fein, and P. B. Pai. 1992. Nonresolving pneumonia in steroid-treated patients with obstructive lung disease. Am. J. Med. 93:29-34.
44. Muder, R. R., and V. L. Yu. 1986. Mode of transmission of Legionella pneumophila: a critical review. Arch. Intern. Med. 146:1607-1612.
45. Rello, J., M. Ricart, V. Ausina, A. Net, and G. Prats. 1992. Pneumonia due to Haemophilus influenzae among mechanically ventilated patients: incidence, outcome and risk factors. Chest 102:1562-1565.
46. Rello, J., V. Ausina, J. Castella, A. Net, and G. Prats. 1992. Nosocomial respiratory tract infections in multiple trauma patients: influence of level of consciousness with implication for therapy. Chest 102:525-529.
47. Middleton, R., W. A. Broughton, and M. B. Kirkpatrick. 1992. Comparison of four methods for assessing airway bacteriology in intubated, mechanically ventilated patients. Am. J. Med. Sci. 304:239-245.
48. Groeger, J. S., K. K. Guntupalli, M. Strosberg, N. Halpern, R. C. Raphaely, F. Cerra, and W. Kaye. 1993. Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit. Care Med. 21:279-291.
49. Rello, J., E. Quintana, V. Ausina, J. Castella, M. Luquin, A. Net, and G. Prats. 1991. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 100: 439-444.
50. Salo, P., A. Ortqvist, and M. Leinonem. 1995. Diagnosis of bacteremic pneumococcal pneumonia by amplification of pneumolysin gene fragment in serum. J. Infect. Dis. 171:479-482.
51. Schluger, N. W., and W. N. Rom. 1995. The polymerase chain reaction in the diagnosis and evaluation of pulmonary infections. Am. J. Respir. Crit. Care Med. 142:11-16.
52. Baigelman, W., S. Bellin, L. A. Cupples, and M. J. Berenberg. 1989. Bacteriologic assessment of the lower respiratory tract in intubated patients. Crit. Care Med. 17:864-868.
53. Salata, R. S., M. M. Lederman, D. M. Shlaes, M. R. Jacobs, E. Eckstein, D. Tweardy, Z. Toossi, R. Chmielewski, J. Marino, C. H. King, R. C. Graham, and J. J. Ellner. 1987. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am. Rev. Respir. Dis. 135:426-432.
54. Marquette, C. H., H. Georges, F. Wallet, P. Ramon, F. Saulnier, R. Neviere, D. Mathieu, A. Rime, and A.B. Tonnel. 1993. Diagnostic efficiency of enodtracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia: comparison with the protected specimen brush. Am. Rev. Respir. Dis. 148: 138-144.
55. el-Ebiary, M., A. Torres, J. Gonzalez, J. P. de la Bellacasa, C. Garcia, M. T. Jimenez de Anta, M. Ferrer, and R. Rodriguez-Roison. 1993. Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am. Rev. Respir. Dis. 148:1552-1557.
56. Lambert, R. S., L. E. Vereen, and R. B. George. 1989. Comparison of tracheal aspirates and protected brush catheter specimens for identifying pathogenic bacteria in mechanically ventilated patients. Am. J. Med. Sci. 297:377-382.
57. Broughton, W. A., J. B. Bass, and M. B. Kirkpatrick. 1987. The technique of protected brush catheter bronchoscopy. J. Crit. Ill 2:63-70.
58. Meduri, G. U., and J. Chastre. 1992. The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 102:5575-5645.
59. Griffin, J. J., and G. U. Meduri. 1994. New approaches in the diagnosis of nosocomial pneumonia. Med. Clin. North Am. 78:1091-1122.
60. Dreyfuss, D., L. Mier, G. Le Bourdelles, K. Djedaini, P. Brun, Y. Boussougant, and F. Coste. 1993. Clinical significance of borderline quantitative protected brush specimen culture results. Am. Rev. Respir. Dis. 147:941-951.
61. Baker, A. M., D. L. Bowton, and E. F. Haponik 1995. Decision making in nosocomial pneumonia: an analytic approach to the use of quantitative cultures. Chest 107:85-95.
62. Meduri, G. U., D. H. Beals, A. G. Maijub, and V. Baselski. 1991. Protected bronchoalveolar lavage: a new bronchoscopic technique to retrieve uncontaminated distal airways secretions. Am. Rev. Respir. Dis. 143:855-864.
63. Seidenfeld, J. J., D. F. Pohl, R. C. Bell, G. D. Harris, and W. G. Johanson, Jr. 1986. Incidence, site, and outcome of infections in patients with the adult respiratory distess syndrome. Am. Rev. Respir. Dis. 134:12-16.
64. Karnad, A., S. Alvarez, and S. L. Berk. 1985. Pneumonia caused by gram-negative bacilli. Am. J. Med. 79(1A):61-67.
65. Hilf, M., V. L. Yu, J. Sharp, J. J. Zuravleff, J. A. Korvick, and R. R. Muder. 1989. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am. J. Med. 87:540-546.
66. Honeybourne, D. 1994. Antibiotic penetration into lung tissue. Thorax 49:104-106.
67. LaForce, F. M. 1989. Systemic antimicrobial therapy of nosocomial pneumonia: monotherapy versus combination therapy. Eur. J. Clin. Microbiol. Infect. Dis. 8:61-68.
68. Craig, W. 1993. Pharmacodynamics of antimicrobial agents as a basis for determining dosage regimens. Eur. J. Clin. Microbiol. Infect. Dis. 12:s6-s8.
69. Nicolau, D. P., C. D. Freeman, P. P. Belliveau, C. H. Nightingale, J. W. Ross, and R. Quintiliani. 1995. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. Antimicrob. Agents Chemother. 39:650-655.
70. Prins, J. M., H. R. Buller, E. J. Kuijper, R. A. Tange, and P. Speelman. 1993. Once versus thrice daily gentamicin in patients with serious infections. Lancet 341:335-339.
71. Lortholary, O., M. Tod., Y. Cohen, and O. Petitjean. 1995. Aminoglycosides. Med. Clin. North Am. 79:761-787.
72. Chow, J. W., M. J. Fine, D. M. Shlaes, J. P. Quinn, D. C. Hooper, M. P. Johnson, R. Ramphal, M. M. Wagener, D. K. Miyashiro, and V. L. Yu. 1991. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann. Intern. Med. 115:585-590.
73. Khan, F. A., and R. Basir. 1989. Sequential intravenous-oral administration of ciprofloxicin versus ceftazidime in serious bacterial respiratory tract infections. Chest 96:528-537.
74. Fink, M. P., D. R. Snydman, M. S. Niederman, K. V. Leeper, Jr., R. H. Johnson, S. O. Heard, R. G. Wunderink, J. W. Caldwell, J. J. Schentag, and G. A. Siami. 1994. Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. The Severe Pneumonia Study Group. Antimicrob. Agents Chemother. 38:547-557.
75. Cometta, A., J. D. Baumgartner, D. Lew, W. Zimmerli, D. Pittet, P. Chopart, U. Schaad, C. Herter, P. Eggimann, and O. Huber. 1994. Prospective randomized comparison of imipenem monotherapy with imipenem plus netilmicin for treatment of severe infections in nonneutropenic patients. Antimicrob. Agents Chemother. 38: 1309-1313.
76. Mangi, R. J., T. Greco, J. Ryan, G. Thornton, and V. T. Andriole. 1988. Cefoperaxone versus combination antibiotic therapy of hospital-acquired pneumonia. Am. J. Med. 84:68-74.
77. Salacata, A., and J. W. Chow. 1993. Cephalosporin therapeutics for intensive care infections. New Horizons 1:181-186.
78. Moore, R. D., C. R. Smith, and P. S. Lietman. 1984. Association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia. Am. J. Med. 77:657-662.
79. Bodem, C. R., L. M. Lampton, D. P. Miller, E. F. Tarka, and E. D. Everett. 1983. Endobronchial pH: relevance to aminoglycoside activity in gram-negative bacillary pneumonia. Am. Rev. Respir. Dis. 127:39-41.
80. Stratton, C. 1992. Fluoroquinolones antibiotics: properties of the class and individual agents. Clin. Ther. 14:348-375.
81. Silver, D. R., I. L. Cohen, and P. F. Weinberg. 1992. Recurrent Pseudomonas aeruginosa pneumonia in an intensive care unit. Chest 101:194-198.
82. Paladino, J. A., H. E. Sperry, J. M. Backes, J. A. Gelber, D. J. Serrianne, T. J. Cumbo, and J. J. Schentag. 1991. Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics. Am. J. Med. 91:462-470.
83. Lowenkron, S. W., and M. S. Niederman. 1992. Definition and evaluation of the resolution of nosocomial pneumonia. Semin. Respir. Infect. 7:271-281.
84. Montravers, P., J. Y. Fagon, J. Chastre, M. Lesco, M. C. Dombret, J. L. Trouillet, and C. Gibert. 1993. Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am. Rev. Respir. Dis. 147:38-44.
85. Wunderink, R. G., L. S. Woldenberg, J. Zeiss, C. M. Day, J. Ciemins, and D. A. Lacher. 1992. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest 101:458-463.
86. Meduri, G. U., and A. Chinn. 1994. Fibroproliferation in late adult respiratory distress syndrome: pathophysiology, clinical and laboratory manifestations, and response to corticosteroid rescue treatment. Chest 105:127s-129s.
87. Rouby, J. J., P. Laurent, M. Gosnach, E. Cambau, G. Lamas, A. Zouaoui, J. L. Leguillou, L. Bodin, T. D. Khac, and C. Marsault. 1994. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am. J. Respir. Crit. Care Med. 150: 776-783.
88. Meduri, G. U., G. L. Mauldin, R. G. Wunderink, K. V. Leeper, Jr., C. B. Jones, E. Tolley, and G. Mayhall. 1994. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 106:221-235.
89. Bell, R. C., J. J. Coalson, J. D. Smith, and W. G. Johanson, Jr. 1983. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann. Intern. Med. 99:293-298.
90. Moore, F. A., E. E. Moore, T. N. Jones, B. L. McCroskey, and V. M. Peterson. 1989. TEN versus TPN following major abdominal trauma: reduced septic mortality. J. Trauma 29:916-923.
91. Kolleff, M. H. 1993. Ventilator-associated pneumonia: a multivariate analysis. J.A.M.A. 270;1965-1970.
92. Tryba, M. 1991. Sucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: a meta-analysis on efficacy and pneumonia rate. Crit. Care Med. 19:942-949.
93. Cook, D. J., L. A. Laine, G. H. Guyatt, and T. A. Raffin. 1991. Nosocomial pneumonia and the role of gastric pH: a meta-analysis. Chest 100:7-13.
94. Cook, D. J., B. K. Reeve, and C. Scholes, 1994. Histamine-2-receptor antagonist and antacids in the critically ill population: stress ulceration versus nosocomial pneumonia. Infect. Control Hasp. Epidemiol. 15:437-442.
95. Martin, L. F., F. V. Booth, R. G. Karlstadt, J. H. Silverstein, D. M. Jacobs, J. Hampsey, S. C. Bowman, C. A. D'Ambrosio, and F. W. Rockhold. 1993. Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit. Care Med. 21:19-30.
96. Dreyfuss, D., K. Djedaini, P. Weber, P. Brun, J. J. Lanore, J. Rahmani, Y. Boussougant, and F. Coste. 1991. Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am. Rev. Respir. Dis. 143:738-743.
97. Dreyfuss, D., K. Djedaini, I. Gros, L. Mier, G. Le Bourdelles, Y. Cohen, P. Estagnasie, F. Coste, and Y. Boussougant. 1995. Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects on patient colonization and incidence of nosocomial pneumonia. Am. J. Respir. Crit. Care Med. 151:986-992.
98. Mahul, P., C. Auboyer, R. Jospe, A. Ros, C. Guerin, Z. el Khouri, M. Galliez, A. Dumont, and O. Gaudin. 1992. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med. 18:20-25.
99. Valles, J., A. Artigas, J. Rello, N. Bonsoms, D. Fontanals, L. Blanch, R. Fernandez, F. Baigorri, and J. Mestre. 1995. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann. Intern. Med. 122:179-186.
100. Sahn, S. A. 1991. Continuous lateral rotational therapy and nosocomial pneumonia. Chest 99:1263-1267.
101. deBoisblanc, B. P., M. Castro, B. Everret, J. Grender, C. D. Walker, and W. R. Summer. 1993. Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest 103:1543-1547.
102. Selective Decontamination of the Digestive Tract Trialists' Collaborative Group. 1993. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. B.M.J. 307:525-532.
103. Gastinne, H., M. Wolff, F. Delatour, F. Faurisson, and S. Chevret. 1992. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N. Engl. J. Med. 326:594-599.
104. Ferrer, M., A. Torres, J. Gonzalez, J. Puig de la Bellacasa, M. el-Ebiary, M. Roca, J. M. Gatell, and R. Rodriguez-Roisin. 1994. Utility of selective digestive decontamination in mechanically ventilated patients. Ann. Intern. Med. 120:389-395.
105. Feely, T. W., G. C. DuMoulin, J. Hedley-Whyte, L. S. Bushnell, J. P. Gilbert, and D. S. Feingold. 1975. Aerosol polymyxin and pneumonia in seriously ill patients. N. Engl. J. Med. 293:471-475.
106. White, J. C., S. Nelson, J. A. Winklestein, F. V. Booth, and G. J. Jakab. 1986. Impairment of antibacterial defense mechanisms of the lung by extrapulmonary infection. J. Infect. Dis. 153:202-208.
107. Cross, A. S., S. M. Opal, J. E. Palardy, M. W. Bodmer, and J. C. Sadoff. 1993. The efficacy of combination immunotherapy in experimental Pseudomonas sepsis. J. Infect. Dis. 167:112-118.
108. deBoisblanc, B. P., W. R. Summer, C. Mason, J. Shellito, E. Logan, M. Bear, S. Johnson, and S. Nelson. 1993. Phase 1 trial of granulocyte colony-stimulating factor in severe community-acquired pneumonia (abstract). Am. Rev. Respir. Dis. 147:A204.
109. Polk, H. C., Jr., W. G. Cheadle, D. H. Livingston, J. L. Rodriguez, K. M. Starko, A. E. Izu, H. S. Jaffe, and G. Sonnenfeld. 1992. A randomized prospective clinical trial to determine the efficacy of interferon-gamma in severely injured patients. Am. J. Surg. 163: 191-196.
110. Beck, J. M., H. D. Liggitt, E. N. Brunette, H. J. Fuchs, J. E. Shellito, and R. J. Debs. 1991. Reduction in intensity of Pneumocystis carinii pneumonia in mice by aerosol administration of gamma interferon. Infect. Immunol. 59:3859-3862.
111. Jaffe, H. A., R. Buhl, A. Mastrangeli, K. J. Holroyd, C. Saltini, D. Czerski, H. S. Jaffe, S. Kramer, S. Sherwin, and R. G. Crystal. 1991. Organ specific cytokine therapy: local activation of mononuclear phagocytes by delivery of an aerosol of recombinant interferon-gamma to the human lung. J. Clin. Invest. 88:297-302.