Treatment was adapted when microbiological results were available. When no pathogen was identified, initial treatment was prolonged to 14 days [2].De-escalation is defined by adaptation from a broad-spectrum antibiotics combination therapy to a targeted and shortened treatment http://www.selleckchem.com/products/jq1.html guided by antibiogram. When identification and antibiogram were available, the duration of treatment was adapted to the identified bacteria: 7 days in all cases except for Pseudomonas aeruginosa (14 days), Legionnella pneumophilia (21 days) and Mycobacterium tuberculosis (6 months).Data recordedWe recorded the patients’ characteristics, including sex ratio, Fine score, and HCAP criteria (Table (Table1).1). We used the Fine score to categorize the severity of pneumonia [13,14].

Table 1Patients’ characteristicsComplications possibly related to bronchoscopy were categorized as follows: death in the first six hours; requiring tracheal intubation in the first six hours; requiring more than six hours of continuous NIV after mini-BAL without requiring NIV before mini-BAL; hemoptysis; and pneumothorax.Statistical analysisThe primary endpoint was to compare the pathogen identification rate of two microbiological techniques: blood cultures versus FODP mini-BAL. Deschamps et al. reported a 40% identification rate with BAL and 5.7% with blood cultures in patients with hospital-acquired pneumonia [15]. According to these previous results, we calculated that 49 patients were required in order to have an 80% power for detecting a 25% absolute difference in pathogen identification between the fiberoptic and blood culture techniques with a two-sided chi-square test and �� set at 0.

05. Continuous variables were compared using paired or unpaired Wilcoxon rank-sum tests. Categorical variables were compared using the chi-square test or Fisher’s exact test when appropriate. A P-value < .05 was considered statistically significant. All statistical analyses were performed using JMP 8.0.1 statistical software (SAS Institute, Cary, NC, USA).ResultsPatient characteristicsBetween February 2008 and February 2010, 49,706 patients were admitted to the emergency department; 542 patients had pneumonia and 75 patients met HCAP criteria. We excluded 21 patients: 13 for exclusion criteria, 5 for technical problems (unavailable fiberscope or operator) and 3 for missing data.

Finally, 54 patients with HCAP were included in the study (Figure (Figure2).2). Patient characteristics are shown in Table Table1.1. A total of 27 patients were hospitalized in the ICU (50%), 9 in the intermediate care department (17%), 11 in the respiratory department (20%) and 7 in other departments (13%) (Figure (Figure2).2). The mean Fine Cilengitide score was 134 �� 17.5 without antibiotic therapy versus 156 �� 19.5 with previous antibiotic therapy (P <0.05). The mean CURB65 score was 1.6 �� 1.Figure 2Flow chart.