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Nosocomial
bacterial pneumonia has been difficult to diagnose . Frequently, the criteria for
diagnosis are fever, cough, and development of purulent sputum, in conjunction with
radiologic evidence of a new or progressive pulmonary infiltrate, a suggestive Gram stain,
and positive cultures of sputum, tracheal aspirate, pleural fluid, or blood. Although
clinical findings in conjunction with cultures of sputum or tracheal specimens may be
sensitive for bacterial pathogens, they are highly nonspecific, especially in patients
receiving mechanically assisted ventilation ; conversely, cultures of blood or pleural
fluid have very low sensitivity . |