Everything about ventilator associated pneumonia is contentious. What is the microbial pathogenesis? How can it be prevented? How should it be treated? One strongly advocated preventive strategy consists of intensive topical and systemic antimicrobial prophylaxis. An opposing but equally strongly advocated approach is the use of conventional but firmly applied infection control measures together with limitation of antibiotic use. For treatment, questions abound. One drug or two? Which drug? For how long?

There are two main reasons which underlie our failure to move toward consensus on many of these questions. Firstly, the magnitude and nature of the problem varies widely between intensive care units. The incidence of pneumonia in mechanically ventilated patients ranges from as little as 5% in some units to more than 50% in others.^1-4 This may represent, in part, differences in diagnostic approach, but most of the difference in incidence is probably real, reflecting differences in patient . . . [Full text of this article]