Bronchoscopy in nonresolving nosocomial pneumonia.

F ew investigators have studied the role of bronchoscopy in evaluating and managing patients with nosocomial pneumonia who are not responding to initial antibiotic therapy. This discussion examines whether the information provided by bronchoscopy has value in this setting, as well as whether the concept of using bronchoscopy for the nonresponding patient is a logical one. Importantly, serial bronchoscopy is generally performed while the patient is receiving antibiotic therapy. Such therapy can reduce the yield and accuracy of quantitative cultures of respiratory secretions. The presumption for using serial cultures in the nonresponding patient is that bacteria are present that have not been eliminated by currently administered antibiotics. Moreover, these organisms can be identified early enough so that changes in therapy will improve the outcome in these patients.