Infectious Complications in Mechanically Ventilated Patients

  • Ari R. JoffeEmail author


Ventilator-associated pneumonia (VAP) is common in intensive care and associated with significant morbidity and likely mortality. There is no gold standard for the diagnosis of VAP, and this has hampered investigation of diagnosis and therapy. There is a paucity of pediatric studies, and most of the current approach is based on extrapolation from adult studies. It appears that invasive bronchoscopic (bronchoalveolar lavage, protected specimen brush), invasive nonbronchoscopic (blind bronchoalveolar lavage, blind protected specimen brush), and noninvasive (endotracheal aspirate) culture techniques are equivalent in aiding diagnosis and treatment of VAP. On clinical suspicion of VAP, empiric antibiotics should be started early, be broad spectrum, and likely be de-escalated on clinical and microbiologic reassessment at 48–72 h. There is even less information on pediatric ventilator-associated sinusitis (VAS). Radiologic diagnosis of sinus disease (with computed tomography) is sensitive but nonspecific, and antral puncture for quantitative culture is required for a definitive diagnosis.


Ventilator Tubing Selective Digestive Decontamination Clinical Pulmonary Infection Score Protected Specimen Brush Nasotracheal Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Albert M, Friedrich JO, Adhikari NKJ, Day AG, Verdant C, Heyland DK (2008) Utility of gram stain in the clinical management of suspected ventilator associated pneumonia: secondary analysis of a multicenter randomized trial. J Crit Care 23:74–81PubMedCrossRefGoogle Scholar
  2. Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A (2004) Ventilator associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30 month prospective surveillance. Infect Control Hosp Epidemiol 25:753–758PubMedCrossRefGoogle Scholar
  3. ATS (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416CrossRefGoogle Scholar
  4. Berdal JE, Bjornholt J, Blomfeldt A, Smith-Erichsen N, Bukholm G (2007) Patterns and dynamics of airway colonization in mechanically ventilated patients. Clin Microbiol Infect 13:476–480PubMedCrossRefGoogle Scholar
  5. Bigham MT, Amato R, Bondurrant P, Fridriksson J, Krawczeski CD, Raake J, Ryckman S, Schwartz S, Shaw J, Wells D, Brilli RJ (2009) Ventilator associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 154:582–587PubMedCrossRefGoogle Scholar
  6. Bonten MJ, Bergmans DC, Ambergen AW, de Leeuw PW, van der Geest S, Stobberingh EE, Gaillard CA (1996) Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med 154:1339–1346PubMedCrossRefGoogle Scholar
  7. Bonten MJM, Kollef MH, Hall JB (2004) Risk factors for ventilator associated pneumonia: from epidemiology to patient management. Clin Infect Dis 38:1141–1149PubMedCrossRefGoogle Scholar
  8. Bregeon F, Papazian L, Visconti A et al (1997) Relationship of microbiologic diagnostic criteria to morbidity and mortality in patients with VAP. JAMA 277:655–662PubMedCrossRefGoogle Scholar
  9. Bregeon F, Papazian L, Thomas P et al (2000) Diagnostic accuracy of protected catheter sampling in VAP. Eur Respir J 16:969–975PubMedCrossRefGoogle Scholar
  10. Canadian Critical Care Trials Group (2006) A randomized trial of diagnostic techniques for ventilator associated pneumonia. N Engl J Med 355:2619–2630CrossRefGoogle Scholar
  11. CDC (2004) Guidelines for preventing health care associated pneumonia 2003. MMWR Recomm Rep 53(RR-3):1–36Google Scholar
  12. Cendrero JAC, Sole-Violan J, Benitez AB, Catalan JN, Fernandez JA, Santana PS, de Castro FR (1999) Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 116:462–470CrossRefGoogle Scholar
  13. Chan EY, Ruest A, Meade MO, Cook DJ (2007) Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 334:889PubMedCentralPubMedCrossRefGoogle Scholar
  14. Chastre J, Fagon JY (2002) VAP. Am J Respir Crit Care Med 165:867–903PubMedCrossRefGoogle Scholar
  15. Chastre J, Fagon JY, Bornet-Lecso M et al (1995) Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 152:231–240PubMedCrossRefGoogle Scholar
  16. Chastre J, Wolff M, Fagon JY et al (2003) Comparison of 8 vs 15 days of antibiotic therapy for VAP in adults: a randomized trial. JAMA 290:2588–2598PubMedCrossRefGoogle Scholar
  17. Clec’h C, Timsit JF, De Lassence A et al (2004) Efficacy of adequate early antibiotic therapy in VAP: influence of disease severity. Intensive Care Med 30:1327–1333PubMedCrossRefGoogle Scholar
  18. Cohen J, Brun-Buisson C, Torres A, Jorgensen J (2004) Diagnosis of infection in sepsis: an evidence-based review. Crit Care Med 32(Suppl):S466–S494PubMedCrossRefGoogle Scholar
  19. Collard HR, Saint S, Matthay MA (2003) Prevention of ventilator associated pneumonia: an evidence based systematic review. Ann Intern Med 138:494–501PubMedCrossRefGoogle Scholar
  20. Corley DE, Kirtland SH, Winterbauer RH et al (1997) Reproducibility of the histologic diagnosis of pneumonia among a panel of four pathologists: analysis of a gold standard. Chest 112:458–465PubMedCrossRefGoogle Scholar
  21. de Smet AMGA, Kluytmans JAJW, Cooper BS, Mascini EM, Benus RFJ, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJM, Bernards AT, Kuijper EJ, Joore JCA, Leverstein-van Hall MA, Bindels AJGH, Jansz AR, Wesselink RMJ, de Jongh BM, Dennesen PJW, van Asselt GJ, te Velde LF, Frenay IHME, Kaasjager K, Gosch FH, van Iterson M, Thijsen SFT, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LPHJ, Sturn PDJ, Harinck HIJ, Voss A, Uijtendaal EV, Blok HEM, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJM (2009) Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360:20–31PubMedCrossRefGoogle Scholar
  22. Dennesen PJW, van der Ven AJAM, Kessels AGH et al (2001) Resolution of infectious parameters after antimicrobial therapy in patients with VAP. Am J Respir Crit Care Med 163:1371–1375PubMedCrossRefGoogle Scholar
  23. Dodek P, Keenan S, Cook D et al (2004) Evidence-based clinical practice guideline for the prevention of VAP. Ann Intern Med 141:305–313PubMedCrossRefGoogle Scholar
  24. Drakulovic MB, Torres A, Bauer TT et al (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 354:1851–1858PubMedCrossRefGoogle Scholar
  25. Elward AM, Warren DK, Fraser VJ (2002) VAP in PICU patients: risk factors and outcomes. Pediatrics 109:758–764PubMedCrossRefGoogle Scholar
  26. Ewig S, Torres A, El-Ebiary M, Fabregas N, Hernandez C, Gonzalez J, Nicolas JM, Soto L (1999) Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Am J Respir Crit Care Med 159:188–198PubMedCrossRefGoogle Scholar
  27. Fabregas N, Torres A, El-Ebiary M et al (1996) Histopathologic and microbiologic aspects of VAP. Anesthesiology 84:760–771PubMedCrossRefGoogle Scholar
  28. Fabregas N, Ewig S, Torres A et al (1999) Clinical diagnosis of VAP revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 54:867–873PubMedCentralPubMedCrossRefGoogle Scholar
  29. Fartoukh M, Maitre B, Honore S et al (2003) Diagnosing pneumonia during mechanical ventilation: the CPIS revisited. Am J Respir Crit Care Med 168:173–179PubMedCrossRefGoogle Scholar
  30. Fayon MJ, Tucci M, Lacroix J, Farrell CA et al (1997) Nosocomial pneumonia and tracheitis in a PICU: a prospective study. Am J Respir Crit Care Med 155:162–169PubMedCrossRefGoogle Scholar
  31. Fischer JE, Janousek M, Nadal D, Fanconi S (1998) Diagnostic techniques for VAP. Lancet 352:1066PubMedCrossRefGoogle Scholar
  32. Fischer JE, Allen P, Fanconi S (2000) Delay of extubation in neonates and children after cardiac surgery: impact of VAP. Intensive Care Med 26:942–949PubMedCrossRefGoogle Scholar
  33. Fowler RA, Flavin KE, Barr J et al (2003) Variability in antibiotic prescribing patterns and outcomes in patients with clinically suspected VAP. Chest 123:835–844PubMedCrossRefGoogle Scholar
  34. Fox G, Leasa DJ, Sibbald WJ, McCormack DG (1995) Reproducibility of PSB cultures in critically ill patients with suspected nosocomial pneumonia. Can Respir J 2:173–178Google Scholar
  35. Garrouste-Orgeas M, Chevret S, Arlet G, Marie O, Rouveau M, Popoff N, Schlemmer B (1997) Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. Am J Respir Crit Care Med 156:1647–1655PubMedCrossRefGoogle Scholar
  36. Gauvin F, Lacroix J, Guertin MC et al (2002) Reproducibility of blind protected BAL in mechanically ventilated children. Am J Respir Crit Care Med 165:1618–1623PubMedCrossRefGoogle Scholar
  37. Gauvin F, Dassa C, Chaibou M et al (2003) VAP in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med 4:437–443PubMedCrossRefGoogle Scholar
  38. Gerbeaux P, Ledoray V, Boussuges A et al (1998) Diagnosis of nosocomial pneumonia in mechanically ventilated patients: repeatability of the BAL. Am J Respir Crit Care Med 157:76–80PubMedCrossRefGoogle Scholar
  39. Gerber JS, Coffin SE, Smathers SA, Zaoutis TE (2009) Trends in the incidence of methicillin-resistant Staphylococcus aureus infection children’s hospitals in the United States. Clin Infect Dis 49:65–71PubMedCentralPubMedCrossRefGoogle Scholar
  40. Goffken G, Niederman MS (2002) Nosocomial pneumonia: the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest 122:2183–2196CrossRefGoogle Scholar
  41. Grobskopf LA, Sinkowitz-Cochran RL, Garrett DO et al (2002) A national point-prevalence survey of PICU-acquired infections in the United States. J Pediatr 140:432–438CrossRefGoogle Scholar
  42. Grossman RF et al (2000) Evidence-based assessment of diagnostic tests for VAP. Chest 117(Suppl 4):177S–218SPubMedCrossRefGoogle Scholar
  43. Heyland DK, Dodek P, Muscedere J, Day A, Cook D, Canadian Critical Care Trials Group (2008) Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator associated pneumonia. Crit Care Med 36:737–744PubMedCrossRefGoogle Scholar
  44. Holzapfel L, Chevret S, Madiniere G et al (1993) Influence of long term oro or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med 21:1132–1138PubMedCrossRefGoogle Scholar
  45. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332PubMedCrossRefGoogle Scholar
  46. Hozapfel L, Chastang C, Demingeon G, Bohe J, Piralla B, Coupry A (1999) A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Am J Respir Crit Care Med 159:695–701CrossRefGoogle Scholar
  47. International Nosocomial Infection Control Consortium (2008) Report, data summary for 2002–2007, issued January 2008. Am J Infect Control 36:627–637CrossRefGoogle Scholar
  48. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH (2002) Clinical importance of delays in the initiation of appropriate antibiotic treatment for VAP. Chest 122:262–268PubMedCrossRefGoogle Scholar
  49. Joffe AR, Muscedere J, Marshall JC, Su Y, Heyland DK (2008) The safety of targeted antibiotic therapy for ventilator associated pneumonia: a multicenter observational study. J Crit Care 23:82–90PubMedCrossRefGoogle Scholar
  50. Kirtland SH, Corley DE, Winterbauer RH et al (1997) The diagnosis of VAP: a comparison of histologic, microbiologic, and clinical criteria. Chest 112:445–457PubMedCrossRefGoogle Scholar
  51. Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital morality among critically ill patients. Chest 115:462–474PubMedCrossRefGoogle Scholar
  52. Kollef MH, Morrow LE, Niederman MS, Leeper KV, Anzueto A, Benz-Scott L, Rodino FJ (2006) Clinical characteristics and treatment patterns among patients with ventilator associated pneumonia. Chest 129:1210–1218PubMedCrossRefGoogle Scholar
  53. Labenne M, Poyart C, Rambaud C et al (1999) Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med 27:2537–2543PubMedCrossRefGoogle Scholar
  54. Lauzier F, Ruest A, Cook D, Dodek P, Alberta M, Shorr AF, Day A, Jiang X, Heyland D, Canadian Critical Care Trials Group (2008) The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator associated pneumonia. J Crit Care 23:50–57PubMedCrossRefGoogle Scholar
  55. Leone M, Garcin F, Bouvenot J, Boyadjev I, Visintini P, Albanese J, Martin C (2007) Ventilator associated pneumonia: breaking the vicious circle of antibiotic overuse. Crit Care Med 35:379–385PubMedCrossRefGoogle Scholar
  56. Luna CM, Vujacich P, Niederman MS et al (1997) Impact of BAL data on the therapy and outcome of VAP. Chest 111:676–685PubMedCrossRefGoogle Scholar
  57. Luna CM, Blanzaco D, Niederman MS et al (2003) Resolution of VAP: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 31:676–682PubMedCrossRefGoogle Scholar
  58. Luna CM, Bruno DA, Garcia-Morato J, Mann KC, Patron JR, Sagardia J, Absi R, Garcia M, Marchetti D, Familglietti A, Baleztena M, Biancolini C (2009) Effect of linezolid compared with glycopeptides in methicillin-resistant Staphylococcus aureus severe pneumonia in piglets. Chest 135:1564–1571PubMedCrossRefGoogle Scholar
  59. Luyt CE, Chastre J, Fagon JY, VAP Trial Group (2004) Value of the CPIS for the identification and management of VAP. Intensive Care Med 30:844–852PubMedCrossRefGoogle Scholar
  60. Marquette CH, Copin MC, Wallet F et al (1995) Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. Am J Respir Crit Care Med 151:1878–1888PubMedCrossRefGoogle Scholar
  61. Marshall JC, Maier RV, Jimenez M, Dellinger EP (2004) Source control in the management of severe sepsis and septic shock: an evidence based review. Crit Care Med 32(Suppl):S513–S526PubMedCrossRefGoogle Scholar
  62. Meersseman W, Lagrou K, Spriet I, Maertens J, Verbeken E, Peetermans WE, Van Wijngaerden E (2009) Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective autopsy study. Intensive Care Med 35:1526–1531PubMedCrossRefGoogle Scholar
  63. Micek ST, Ward S, Fraser VJ, Kollef MH (2004) A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected VAP. Chest 125:1791–1799PubMedCrossRefGoogle Scholar
  64. Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D, VAP Guidelines Committee and the Canadian Critical Care Trials Group (2008a) Comprehensive evidence based clinical practice guidelines for ventilator associated pneumonia: diagnosis and treatment. J Crit Care 23:138–147PubMedCrossRefGoogle Scholar
  65. Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D, VAP Guidelines Committee and the Canadian Critical Care Trials Group (2008b) Comprehensive evidence based clinical practice guidelines for ventilator associated pneumonia: prevention. J Crit Care 23:126–137PubMedCrossRefGoogle Scholar
  66. National Healthcare Safety Network (NHSN) (2008) National Healthcare Safety Network (NHSN). Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 36:609–626CrossRefGoogle Scholar
  67. NNIS (2000) NNIS System Report, data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 29:404–421Google Scholar
  68. NNIS (2004) NNIS System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRefGoogle Scholar
  69. O’Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, Linden P, Maki DG, Nierman D, Pasculle W, Masur H (2008) Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 36:1330–1349PubMedCrossRefGoogle Scholar
  70. Oudhuis GJ, Beuving J, Bergmans D, Stobberingh EE, Velde GT, Linssen CF, Verbon A (2009) Soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid is not predictive for ventilator-associated pneumonia. Intensive Care Med 35:1265–1270PubMedCentralPubMedCrossRefGoogle Scholar
  71. Papazian L, Thomas P, Garbe L et al (1995) Bronchoscopic or blind sampling techniques for the diagnosis of VAP. Am J Respir Crit Care Med 152:1982–1991PubMedCrossRefGoogle Scholar
  72. Paul M, Soares-Weiser K, Leibovici L (2003) Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis. BMJ 326:1111–1120PubMedCentralPubMedCrossRefGoogle Scholar
  73. Paul M, Benuri-Silbiger I, Soares-Weiser K, Leibovici L (2004) Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomized trials. BMJ 328:668PubMedCentralPubMedCrossRefGoogle Scholar
  74. Pugin J, Auckenthaler R, Mili N et al (1991) Diagnosis of VAP by bacteriologic analysis of bronchoscopic and nonbronchoscopic blind BAL fluid. Am Rev Respir Dis 143:1121–1129PubMedCrossRefGoogle Scholar
  75. Raymond J, Aujard Y, European Study Group (2000) Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 21:260–263PubMedCrossRefGoogle Scholar
  76. Rea-Neto A, Youssef NCM, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, Sakr Y (2008) Diagnosis of ventilator associated pneumonia: a systematic review of the literature. Crit Care 12:R56PubMedCentralPubMedCrossRefGoogle Scholar
  77. Richards MJ, Edwards JR, Culver EH, Gaynes RP, NNIS (1999) Nosocomial infections in PICUs in the United States. Pediatrics 103:e39PubMedCrossRefGoogle Scholar
  78. Rizolli SB, Marshall JC (2001) Saturday night fever: finding and controlling the source of sepsis in critical illness. Lancet Infect Dis 2:137–144CrossRefGoogle Scholar
  79. Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, McTaggart B, Weiss K, Zhanel GG (2008) Clinical practice guidelines for hospital acquired pneumonia and ventilator associated pneumonia in adults. Can J Infect Dis Med Microbiol 19:19–53PubMedCentralPubMedGoogle Scholar
  80. Rouby JJ, de Lassale EM, Poete P et al (1992) Nosocomial bronchopneumonia in the critically ill: histologic and bacteriologic aspects. Am Rev Respir Dis 146:1059–1066PubMedCrossRefGoogle Scholar
  81. Safdar N, Dezfulian C, Collard H, Saint S (2005) Clinical and economic consequences of ventilator associated pneumonia: a systematic review. Crit Care Med 33:2184–2193PubMedCrossRefGoogle Scholar
  82. Schurink CAM, van Nieuwenhoven CAV, Jacobs JA et al (2004) CPIS for VAP: accuracy and inter-observer variability. Intensive Care Med 30:217–224PubMedCrossRefGoogle Scholar
  83. Shorr AF, Sherner JH, Jackson WL, Kollef MH (2005) Invasive approaches to the diagnosis of VAP: a meta-analysis. Crit Care Med 33:46–53PubMedCrossRefGoogle Scholar
  84. Singh N, Rogers P, Atwood CW et al (2000) Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the ICU: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 162:505–511PubMedCrossRefGoogle Scholar
  85. Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR (2009) A prospective study of ventilator associated pneumonia in children. Pediatrics 123:1108–1115PubMedCrossRefGoogle Scholar
  86. Timsit JF, Misset B, Francoual S et al (1993) Is PSB a reproducible method to diagnose ICU-acquired pneumonia. Chest 104:104–108PubMedCrossRefGoogle Scholar
  87. Torres A, El-Ebiary M, Padro L et al (1994) Validation of different techniques for the diagnosis of VAP: comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med 149:324–331PubMedCrossRefGoogle Scholar
  88. Torres A, El-Ebiary M, Soler N, Monton C, Fabregas N, Hernandez C (1996) Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator associated pneumonia. Eur Respir J 9:1729–1735PubMedCrossRefGoogle Scholar
  89. Torres A, Fabregas N, Ewig S et al (2000) Sampling methods for VAP: validation using different histologic and microbiological references. Crit Care Med 28:2799–2804PubMedCrossRefGoogle Scholar
  90. Torres A, Ewig S, Lode H, Carlet J, European HAP Working Group (2009) Defining, treating, and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 35:9–29PubMedCrossRefGoogle Scholar
  91. van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, Joore HCA, van Schijndel RJMS, van der Tweel I, Ramsay G, Bonten MJM (2006) Feasibility and effects of the semirecumbent position to prevent ventilator associated pneumonia: a randomized study. Crit Care Med 34:396–402PubMedCrossRefGoogle Scholar
  92. Venkatachalam V, Hendley JO, Willson DF (2011) The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med 12:286–296PubMedCrossRefGoogle Scholar
  93. Wermert D, Marquette CH, Copin MC et al (1998) Influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in VAP. Am J Respir Crit Care Med 158:139–147PubMedCrossRefGoogle Scholar
  94. Westergren V, Lundblad L, Hellquist HB, Forsum U (1998) Ventilator associated sinusitis: a review. Clin Infect Dis 27:851–864PubMedCrossRefGoogle Scholar
  95. Wunderink RG, Rello J, Cammarata SK, Croos-Dabrera RV, Kollef MH (2003) Linezolid vs vancomycin: analysis of two double blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 124:1789–1797PubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Pediatrics, Pediatric Critical Care Medicine and Infectious DiseasesUniversity of Alberta; 3A3.07 Stollery Children’s HospitalEdmontonCanada

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