TY - JOUR
T1 - Alternative case definitions of ventilator-associated pneumonia identify different patients in a surgical intensive care unit
AU - Minei, Joseph P.
AU - Hawkins, Kenneth
AU - Moody, Barbara
AU - Uchal, Linda B.
AU - Joy, Kathryn
AU - Christensen, Laura L.
AU - Haley, Robert W.
PY - 2000/9
Y1 - 2000/9
N2 - Diagnostic criteria that define ventilator-associated pneumonia (VAP) remain controversial. The purpose of this study was to evaluate common definitions of VAP and determine their relationship to each other and clinical treatment. This study prospectively evaluated several diagnostic criteria that define VAP in a cohort of 255 consecutive SICU patients ventilated for < 48 h. Definitions evaluated include the CDC definitions, the Johanson definitions which do not rely on culture data, the Physician's Probable diagnosis which relies on positive quantitative cultures, and the antibiotic treatment group. Forty-four patients (17%) received antibiotic treatment for VAP. Depending on the definition evaluated, criteria were met for a diagnosis of VAP from as low as 4% of patients by the Johanson definition to as high as 48% of patients by the CDC definition. There was poor agreement among the definitions in their ability to select the same patient as having VAP. Besides duration of mechanical ventilation and tube feeding, which were risk factors that predicted meeting the criteria for all groups, risk factors predicting VAP varied among the definitions. This study demonstrates that in a surgical ICU, the candidate definitions of pneumonia evaluated show little agreement. The particular case definition chosen to diagnose VAP will determine the incidence rate of pneumonia, the time to onset of pneumonia, and the risk factors of the type of patient treated.
AB - Diagnostic criteria that define ventilator-associated pneumonia (VAP) remain controversial. The purpose of this study was to evaluate common definitions of VAP and determine their relationship to each other and clinical treatment. This study prospectively evaluated several diagnostic criteria that define VAP in a cohort of 255 consecutive SICU patients ventilated for < 48 h. Definitions evaluated include the CDC definitions, the Johanson definitions which do not rely on culture data, the Physician's Probable diagnosis which relies on positive quantitative cultures, and the antibiotic treatment group. Forty-four patients (17%) received antibiotic treatment for VAP. Depending on the definition evaluated, criteria were met for a diagnosis of VAP from as low as 4% of patients by the Johanson definition to as high as 48% of patients by the CDC definition. There was poor agreement among the definitions in their ability to select the same patient as having VAP. Besides duration of mechanical ventilation and tube feeding, which were risk factors that predicted meeting the criteria for all groups, risk factors predicting VAP varied among the definitions. This study demonstrates that in a surgical ICU, the candidate definitions of pneumonia evaluated show little agreement. The particular case definition chosen to diagnose VAP will determine the incidence rate of pneumonia, the time to onset of pneumonia, and the risk factors of the type of patient treated.
KW - Diagnosis; mechanical ventilation; bronchoalveolar lavage
KW - Epidemiologic methods
KW - Nosocomial pneumonia
UR - http://www.scopus.com/inward/record.url?scp=0039334747&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0039334747&partnerID=8YFLogxK
U2 - 10.1097/00024382-200014030-00016
DO - 10.1097/00024382-200014030-00016
M3 - Article
C2 - 11028552
AN - SCOPUS:0039334747
SN - 1073-2322
VL - 14
SP - 331
EP - 337
JO - Shock
JF - Shock
IS - 3
ER -