July 2, 1997

Identifying the Causative Organism in Patients With Ventilator-Associated Pneumonia-Reply

Author Affiliations

Hospital Sainte Marguerite Marseille, France

JAMA. 1997;278(1):25. doi:10.1001/jama.1997.03550010039034

In Reply.  —We agree with Drs Marik and Varon that clinical diagnosis alone is not sufficient to draw conclusions regarding the diagnosis of VAP and that a microbiological diagnosis facilitates appropriate antimicrobial therapy. For these reasons, in our analysis, all of the patients were positive for at least 1 microbiological sampling technique; moreover, in 74% of the cases at least 3 techniques were positive in culture. Nevertheless, this presents a good opportunity to state that the unfair criticism the clinical examination has received is no doubt because of poor interpretation of the studies on this subject. Indeed, in the study by Andrews et al,1 the clinical diagnosis was accurate in 71% of the cases. In the study by Fagon et al,2 when there was complete agreement by the medical staff, the clinical diagnosis was correct in 90% of the cases. In the study conducted by our team,3 the clinical