Nosocomial pneumonia continues to be a leading cause of fatal nosocomial infection in the United States. Although there are differences in pathogens by age, the importance of nosocomial pneumonia is apparent in the adult population as well as in the pediatric patient groups. The ability to diagnose these infections utilizing clinical suspicion and microbiologic/rapid diagnostic tests will allow the clinician to effectively treat nosocomial pneumonia in the critically ill patient. Unfortunately, these treatment modalities and preventive measures have not kept pace with our understanding of the pathogenesis of this infection. The pediatric patient population presents several unique and specific infection control, diagnostic and treatment problems for the practicing clinician. The appropriate infection control and isolation policies for specific viral and multiple antibiotic resistant bacterial isolates remains a cornerstone in the prevention of nosocomial pneumonia. The judicious use of empiric antibacterial chemotherapy remains important in the treatment of patients with nosocomial pneumonia. However, in the pediatric patient population the recognition that viral and fungal etiologies are important causes of nosocomial pneumonia challenge the clinician to apply the appropriate diagnostic and effective treatment regimens in pediatric nosocomial pneumonias. The epidemiologic data for the clinician's own institution in regards to etiologic causes of nosocomial pneumonia, drug susceptibility patterns as well as the seasonal and patient distribution of these infections are critical. Nosocomial pneumonia will continue to remain a significant cause of morbidity, mortality, and hospital cost in the United States in the upcoming decades. The advent of new rapid diagnostic testing and improved treatment modalities for effective therapy and prevention will be aided by the advent of immunologic therapy for these disease states. Although these modalities show great promise, it will be up to the clinician to stay current on the field of nosocomial pneumonia as it will continue to be a significant problem.
