Hospital-Acquired Infections Due to Gram-Negative Bacteria

To the Editor: Peleg and Hooper (May 13 issue) 1 stress the importance of preventive measures for ventilator-associated pneumonia. Table 3 of their article lists evidence-based guidelines for the prevention of this infection. We respectfully disagree with the authors' message, since half the mentioned strategies are not evidence-based. Hand washing cannot affect primary endogenous ventilator-associated pneumonia, which is caused by microorganisms present in the patients' oropharyngeal flora on admission to the intensive care unit (ICU). 2 Subglottic drainage provides partial control of ventilator-associated pneumonia, since it mainly prevents primary endogenous ventilator-associated pneumonia caused by common respiratory pathogens, but not secondary endogenous ventilator-associated . . .