Use

It is with great interest buy strattera read the article Marik and Careau

(chest, January 1999). Despite some setbacks

(fast transport, adequate transport medium, and inoculation on

specific media under anaerobic conditions), only one anaerobic bacteria >> << was isolated in this study leads to the conclusion that

anaerobic bacteria can not be involved in these infections

and antibiotics effective against anaerobic bacteria can not be

useful as empirical treatment in these situations. However, it is good

known that the concentration of anaerobic bacteria in the mouth of the pharynx is

higher than aerobic bacteria. These bacteria colonize the oropharynx

responsible for nosocomial pneumonia. Thus, the inability to distinguish >> << anaerobic bacteria in this study was surprising. Use

specific conditions of transport and culture, we could identify a high percentage >> << anaerobic cultures of protected brush specimens (PSB) at

patients with ventilator-pneumonia (VAP). These >> << significant differences between the results of Marik and Careau and our

could be due to technical differences in laboratory procedures

used to recover anaerobic bacteria from Promsvyazbank. First, we used just

ready meat yeast VL agar (Sanofi Pasteur, Marnes La Coquette, France

) for anaerobic culture. This medium is prepared twice a week >> << and supplemented with 8% sheep blood and gentamicin menadyona,

makes this medium selective for anaerobes. Second, anaerobic atmosphere >> << received in Oxoid jar with Anaerogen Oxoid system

(Oxoid; Beyzinhstouk, England), which gives better results than other >> << test systems (unpublished data). Finally, 2 of 20 technicians in our lab

specifically designed for anaerobic bacteria

Front because their skills in the study of these bacteria. However, a potential concern with antibiotics effective against >> << anaerobic bacteria in patients with nosocomial pneumonia

remains controversial. We recently reported that patients with

VAP receiving well-adapted empiric antibiotherapy against anaerobic bacteria

was the best result in D10. In addition, a recent large study compared the efficacy

ceftazidime against piperacillin-tazobaktam in ICU patients with VAP,

mortality was lower in patients receiving piperacillin-tazobaktam than

patients treated with ceftazidime. Although anaerobic bacteria >> << were not specifically investigated in this study, we

assume that the mortality difference can be explained partly >> << better activity of piperacillin-tazobaktam, than ceftazidime on

anaerobes, which could be associated with aerobic bacteria in

patients with VAP. Finally, because anaerobic bacteria are numerous in the oropharynx >> << and because colonized oropharyngeal content leads to nosocomial pneumonia

, anaerobes associated with aerobic bacteria should be isolated >> << in patients with VAP or aspiration pneumonia. Moreover

several arguments suggest considering these bacteria in the selection

empirical antibiotic therapy in patients with VAP. .