Accuracy of clinical definitions of ventilator-associated pneumonia: Comparison with autopsy findings

Tejerina, Eva; Esteban, Andrés; Fernández-Segoviano, Pilar; Frutos‐Vivar, Fernando; Aramburu, J. A.; Ballesteros, Daniel; Rodríguez-Barbero, J.M.

doi:10.1016/j.jcrc.2009.05.008

Cited by 168 publications

(113 citation statements)

References 14 publications

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“…Despite VAP epidemiological impact, it has no valid and reliable definition and even the most widely used VAP criteria are neither sensitive nor specific (6) and lack accuracy and objectivity (7,12,13), with documented poor correlation between the clinical diagnosis of VAP and histologic examination (14). Clinical scores have been applied but none was consistent in accurately identifying VAP (15).…”

Section: Vap Definitionmentioning

confidence: 99%

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Nora¹,

Póvoa²

2017

Ann. Transl. Med.

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Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

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Section: Vap Definitionmentioning

confidence: 99%

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Nora¹,

Póvoa²

2017

Ann. Transl. Med.

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“…All existing definitions have many subjective components, and none has been shown to be more accurate than another. 20,21 All yield many false positives and false negatives relative to histological evaluation at autopsy. Rather than try to come up with a new VAP definition then, the working group suggested shifting the focus of surveillance away from pneumonia to complications of mechanical ventilation instead.…”

Section: Limitations Of Vap As a Quality Metric For Ventilated Patientsmentioning

confidence: 99%

“…47 Autopsy series also find that 40 -60% of subjects who meet clinical criteria for VAP do not have histological evidence of pneumonia. 21 VAP is therefore a questionable standard against which to measure the accuracy of VAE definitions.…”

Section: The Sensitivity Of Vae Definitions For Vap Is Lowmentioning

confidence: 99%

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Klompas,

Berra

2016

Respir Care

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in 2013. Controversy abounds as to whether VAE definitions are potentially suitable to serve as quality indicators for ICUs. On the pro side, VAE definitions overcome many of the weaknesses of traditional VAP surveillance. VAE definitions are objective, reproducible, electronically computable, and strongly predict poor outcomes for patients. There is an increasing amount of data on clinical correlates, risk factors, and approaches to prevent VAEs. Potential strategies to prevent VAEs are highly aligned with accepted best practices in critical care. VAE surveillance therefore has the potential to catalyze better care and to help hospitals track outcomes in ventilated patients more rigorously and more efficiently. On the con side, the complete VAE definition set with subtiers is complicated, neither sensitive nor specific for VAP, non-physiological compared with other ICU metrics, susceptible to gaming, and may bring about changes in clinician behavior that could paradoxically end up harming patients.

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“…: loose defi nition, 9 rigorous defi nition, 9 the clinical pulmonary infection score (CPIS) . 6, 10,11 the Canadian Critical Care Trials Group (CCCTG) classifi cation (possible type), 12 the International Sepsis Forum Consensus defi nition (probable type), 13 the CDC criteria, 14 and the new VAE algorithm.…”

mentioning

confidence: 99%

Temporal Trends of Ventilator-Associated Pneumonia Incidence and the Effect of Implementing Health-care Bundles in a Suburban Community

Ding

Kılıçkaya

Senkal

et al. 2013

Chest

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Ventilator-associated pneumonia (VAP) is a com mon nosocomial infection, associated with prolonged mechanical ventilation (MV) and ICU stay, as well as increased attributable mortality and health-care cost. 1,2 Background: Recent changes in critical care delivery, including the widespread implementation of health-care bundles, were aimed at reducing complications of critical illness, in particular ventilatorassociated pneumonia (VAP), but no population-based study evaluated its effectiveness.

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Accuracy of clinical definitions of ventilator-associated pneumonia: Comparison with autopsy findings

Cited by 168 publications

References 14 publications

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Temporal Trends of Ventilator-Associated Pneumonia Incidence and the Effect of Implementing Health-care Bundles in a Suburban Community

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