Key messages

• Nosocomial pneumonia accounts for approximately 10 to 15 per cent of all hospital-acquired infections.

• Ventilator-associated nosocomial pneumonia has the highest mortality of all hospital-acquired infections.

• Leading pathogens are the enteric aerobic Gram-negative bacilli and Staphylococcus aureus. Other organisms, such as Streptococcus pneumoniae or Hemophilus influenzae, are less common.

• Certain circumstances predict the etiology of hospital-acquired pneumonia: the severity of the episode; the presence of coexisting illness; previous antibiotic therapy; the duration of the period in hospital.

• In the case of nosocomial pneumonia affecting ventilated patients, simpler sampling methods such as a quantitative culture of endotracheal aspirates or distal samples obtained by 'blind' procedures are preferable.

• In non-ventilated nosocomial pneumonia, transthoracic or transtracheal aspiration is preferable to bronchoscopic procedures in order to obtain a reliable etiological diagnosis.

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