After recent introduction of an antibiotic treatment for suspected ventilator-associated pneumonia, protected specimen brush and bronchoalveolar lavage culture thresholds must be decreased to maintain good accuracy. In contrast, current antibiotic treatment prescribed for a prior infectious disease does not modify the diagnostic accuracy of protected specimen brush or bronchoalveolar lavage.

A nationwide retrospective study was performed in France to describe the susceptibility of Streptococcus pneumoniae strains to penicillin G and to identify risk factors for infection with nonsusceptible strains. From January 1991 to May 1992, 10,350 S. pneumoniae strains were recorded. The overall rate of penicillin-nonsusceptible pneumococcal (PNSP) strains was 11%; specific prevalence rates, according to the sources of the isolates, were as follows: blood, 6%; cerebrospinal fluid, 10%; lower respiratory tract, 10%; and middle ear, 18%. Large variations in regional distribution were observed. In 85% of cases, PNSP strains belonged to serogroup 23, 19, 6, 14, or 9, by order of decreasing frequency. A logistic regression model identified the following factors as being associated with PNSP infections: age of < 15 years (OR = 2.01), isolation of the organisms from the upper respiratory tract (OR = 2.36) or from sinus and middle ear (OR = 1.63), HIV infection (OR = 2.01), beta-lactam antimicrobial therapy in the previous 6 months (OR = 1.99), and nosocomial acquisition (OR = 2.12). The attributable risk of beta-lactam antimicrobial therapy in the previous 6 months was 19%, showing that suppression of this factor alone could not eradicate PNSP infections.

These preliminary results indicate that postanoxic status epilepticus can be masked by neuromuscular blockade during our protocol of therapeutic hypothermia. Routine EEG monitoring might be helpful in cardiac-arrest survivors receiving therapeutic hypothermia. Further studies including continuous EEG monitoring are needed to determine whether early diagnosis and treatment of ESE during therapeutic hypothermia improves the outcome.