在重症监护病房，抗生素大比例被规定为呼吸机相关肺炎（VAP）的推定事件。VAP通常被诊断上的临床，放射，和微生物学的标准具有高的灵敏度，但特异性低为VAP的组合。其结果是，患者可能会不必要地接收抗生素。特异性可以通过添加保护标本刷（PSB）和支气管肺泡灌洗（BAL）的样品的定量培养诊断标准的增加。我们前瞻性分析中VAP的抗生素处方的诊断实施PSB和BAL的影响。PSB和/或BAL中谁履行了临床，影像学，和微生物标准VAP患者进行。基于PSB和/或BAL的定量培养，患者被分为三组：VAP微生物证明（组1; N = 72）;VAP的临床怀疑不微生物证实（2组; n = 66）;和在其中支气管镜不能执行例（第3组; N = 17）。在组1中，抗生素治疗凭经验在40名患者（56％）（第1a族），并在其它32例患者（组磅）获得培养结果之后被设立。 Adjustment of therapy, based on culture results, occurred in 14 (35%) patients in Group la. In Group 2 empiric therapy was instituted in 34 (52%) patients (Group 2a) and dIscontinued within 48 h in 17 of them (50%). In Group 3, 17 (100%) patients were treated with antibiotics. Among the 66 patients in whom a clinical suspicion of VAP was not confirmed, only 18 (27%) were treated with antibiotics, and antibiotic therapy was withheld in 48 (35%) of 138 patients who underwent bronchoscopy. Withholding of antibiotic therapy had no negative effect on the recurrence of a clinical suspicion of VAP or on mortality rates. We conclude that addition of bronchoscopic techniques to the criteria for VAP may help to reduce antibiotic use. However, the definite benefits and cost-effectiveness of these techniques should be analyzed in a randomized study.