Developments in the pathogenesis, diagnosis and treatment of nosocomial pneumonia.

Despite recent progress in the prevention and therapy of hospital acquired infections, nosocomial pneumonia remains an important problem in critically ill patients. Nosocomial pneumonia develops in five to ten patients per 1,000 admissions and has a mortality rate of 20 to 50 per cent. This review updates three areas that have been the subject of investigation in recent years: pathogenesis, especially the role of gastric colonization with gram-negative bacilli in retrograde pharyngeal spread; diagnosis, particularly by bronchoalveolar lavage and the protected specimen brush during bronchoscopy, and therapy with extended spectrum penicillins, third generation cephalosporins, imipenem, aztreonam and quinolones.