Forced recognition of acute kidney injury.

1355 (15). Although such developments offer future perspectives of targeting these most virulent P. aeruginosa, several questions remain. First, passive immunization requires screening high-risk patients to be targeted, i.e., those infected with a TTSS/exotoxinexpressing strain, which is a screening currently beyond the realm of clinical availability. Were patients not to be screened, it would imply using very costly bioengineered therapy indiscriminately and therefore certainly not cost effectively. Second, TTSS/exotoxin expression is screened in vitro, in culture conditions for maximal expression, without any means to determine real in vivo levels of TTSS/exotoxin expression in patients. Last, while it may be realistic to screen patients for P. aeruginosa tracheal colonization to prevent ventilatoracquired pneumonia through passive immunization, this does not seem feasible in bacteremia, which may arise from a number of colonized/infected sites. While we should undoubtedly follow these exciting developments closely, the same questions will remain in our minds upon diagnosing our next patients with P. aeruginosa bacteremia: what is the source? How severe will this infection be? Which antibiotics should I choose? Eric Kipnis, MD, PhD Surgical Critical Care Unit Department of Anesthesiology and Critical Care Lille University Teaching Hospital Lille, France Karine Faure, MD, PhD Department of Infectious Diseases Lille University Teaching Hospital Lille, France