Key messaqes

• Microbiological cultures of sputum and tracheal aspirates are commonly contaminated with colonizing bacteria and thus are an insensitive method of diagnosing ventilator-associated pneumonia.

• The absence of Gram-negative organisms in sputum and tracheal aspirates excludes them as a cause of ventilator-associated pneumonia.

• The false-negative and false-positive rates from both bronchial lavage and brushings are sufficiently variable, even in experienced hands, for them still to be regarded as investigational tools.

• In institutions routinely handling them, Gram staining of bronchoalveolar lavage and quantitative cultures of protected catheter brushings aid in the diagnosis of ventilator-associated pneumonia, but only in patients who are not on antibiotics.

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