Pneumonia is often misdiagnosed initially
because of the early radiographic appearance of
water in the lungs. In a series of hospitalized
cases, only 12% of persons rescued from drowning had pneumonia and needed treatment with
antibiotic agents.
45
Prophylactically administered antibiotics tend to select more resistant
and aggressive organisms.
46
It is best to monitor patients daily for definite fever, sustained
leukocytosis, persistent or new pulmonary infiltrates, and leukocyte response in the tracheal
aspirate, with culture and sensitivity testing of
sputum specimens obtained daily from the aspirate. In addition, bronchoscopy may be performed to monitor selected patients for pulmonary infection and, on rare occasions, is used for
therapeutic clearing of mucus plugs or solid
material.