The diagnosis of pneumonia at the University of Louisville has been by identification of 3 of 5 clinical markers. These are new onset of fever, decreasing oxygenation, purulent sputum, chest radiographic changes, and/or leukocytosis.

Accurate identification of the causative organism is frequently elusive, however, several methods have found their way into routine use. Bronchioalveolar lavage (BAL) and protected specimen brushings (PSB) provide the most accurate identification of

the causative organism. Sputum gram stain is used to guide empiric therapy despite their reported unreliability in ventilated patients.

Bronchioalveolar lavage and protected specimen brushings have a wide sensitivity and specificity due to a lack of a consensus gold standard for comparison. Quantitative as well as qualitative cultures have been effective in assessing organisms. The current recommendation for a positive BAL is 105 cfu/mL or PSB of 103 cfu/mL.

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