However, the difference in resistance prevalence between nasopharyngeal specimens and sinus aspirates was not great for any species/antibiotic combination, and assuming the majority of isolates were the responsible pathogen, significant bias of resistance patterns is unlikely.
Moreover, Nigrovic and colleagues confirmed that S. pneumoniae is still the responsible pathogen in a substantial proportion of patients with bacterial meningitis in childhood, with half of them caused by non-PCV7-vaccine serotypes [ 36].
Instant diagnosis of the causative organism would be optimal for managing CAP; however, the responsible pathogen is usually not known at the time of CAP diagnosis and no pathogen is identified in up to 50% of patients even after extensive testing for several days [ 14].
However, since the responsible pathogen was not isolated in the majority of the patients, it is not known whether the treatment was the most appropriate in these patients.
The responsible pathogen is a hookwormC.
Antimicrobial treatment was narrowed after identification of the responsible pathogen.
In four of them the responsible pathogen was eradicated, and in one case the pathogen persisted in repeated specimen cultures; this patient died.
The definition of the site of the infection and of the responsible pathogen were based on the clinical symptoms and signs of individual patients, imaging findings, and on the isolation of a possible pathogen from evaluable clinical specimens.
The diagnostic BAL can be implemented in an ASP and deliver important information to confirm an infectious disease, to optimize antimicrobial treatment (e.g. in the presence of Pneumocystis jiroveci), to de-escalate and narrow antibiotic therapy once the responsible pathogen is known and to stop antibiotic therapy in patients unlikely to have infections [ 27, 29].
Stage II involves stopping therapy in patients unlikely to have infections, focusing and narrowing treatment once the responsible pathogen is known, switching to monotherapy after day 3 whenever possible, and shortening antibiotic administration to 7 to 8 days for most patients, based on the therapeutic response and microbiology data.
