Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia

Waltrick, Renata; Possamai, Dimitri Sauter; Aguiar, Fernanda Perito de; Dadam, Micheli; Filho, Valmir João de S; Ramos, Lucas Rocker; Laurett, Renata da Silva; Fujiwara, Kênia; Filho, Milton Caldeira; Köenig, Álvaro; Westphal, Glauco Adrieno

doi:10.5935/0103-507x.20150047

Cited by 23 publications

(31 citation statements)

References 15 publications

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“…In contrast, Waltrick et al 18 reported that the CDC method could not be used as a surveillance method (kappa value 0.47, sensitivity 37%, and specificity 100%, compared to CPIS). This low sensitivity of the CDC criteria in detecting VAP may have been related to several factors, such as age (subjects were >18 years of age), as well as inability of researchers to observe changes in ventilator settings and clinical changes in all VAP patients, other than the cut-off value.…”

Section: Discussionmentioning

confidence: 94%

The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia

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Lestari

Kusumastuti

et al. 2019

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Background Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU), with mortality rates of up to 50%. Post-mortem pulmonary examination is considered to be the gold standard for diagnosis of VAP, but is impossible for routine application. The sensitivity and specificity of Clinical Pulmonary Infection Score (CPIS) are considered to be similar to the those of the gold standard, but the Centers for Disease Control and Prevention PNU-1 (CDC PNU-1) is simpler and not invasive, compared to the CPIS. Objective To evaluate the level of agreement between CDC PNU-1 and CPIS criteria in diagnosing VAP. Methods This cross-sectional study was conducted in the PICU at Dr. Soetomo Hospital, Surabaya from June to October 2018. Subjects were children aged 1 month–18 years who had been intubated for more than 48 hours. The VAP diagnoses were made by CDC PNU-1 and CPIS criteria. The level of agreement between the two methods was evaluated by Cohen’s Kappa test using SPSS Statistics Base 21.0 software. Results hirty-six subjects were evaluated using CDC PNU-1 and CPIS criteria. Subjects’ mean age was 3.5 (SD 4.7) years. Amongst 19 patients with VAP, 14 were diagnosed by CPIS criteria and 17 were diagnosed by CDC PNU-1 criteria. The level of agreement between the CDC PNU-1 and CPIS criteria was good (Kappa 0.61; 95%CI 0.31 to 0.83). The CDC PNU-1 had sensitivity 0.85, specificity 0.77, positive predictive value (PPV) 0.70, and negative predictive value (NPV) 0.89. Conclusion The CDC PNU-1 criteria has a good level of agreement with CPIS criteria in diagnosing VAP.

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Section: Discussionmentioning

confidence: 94%

The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia

Ningtiar

Lestari

Kusumastuti

et al. 2019

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“…[11][12][13] Last, the interpretation of the diagnostic role of PCT in HAP and VAP is confounded by the lack of clear consensus in definitions for these syndromes. 17 These data provide an interesting insight into the role of PCT in facilitating antimicrobial stewardship efforts to reduce unnecessary antimicrobial courses while not adversely affecting the risk of mortality. Recent guidelines for the management of HAP/VAP "strongly recommend" against the routine use of serum PCT in guiding initiation of therapy.…”

Section: Pct In Patients With Respiratory Tract Infectionsmentioning

confidence: 89%

“…The degree of bias that this may introduce remains unclear . Last, the interpretation of the diagnostic role of PCT in HAP and VAP is confounded by the lack of clear consensus in definitions for these syndromes …”

Section: Evidence For Specific Novel Biomarkersmentioning

confidence: 99%

Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

et al. 2018

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As antimicrobial stewardship increasingly receives worldwide attention for improving patient care by optimizing antimicrobial therapy, programs are evaluating new tools that may augment antimicrobial stewardship activities. Biomarkers are objective, accurate, and reproducible measures that provide information about medical conditions. A systematic literature search using PubMed/MEDLINE databases was performed to evaluate the use of novel biomarkers as additions to the antimicrobial stewardship armamentarium. Procalcitonin may help clinicians discriminate between bacterial and viral infections, help with antimicrobial discontinuation decisions, and predict mortality. β‐d‐glucan, Candida albicans germ tube antibody, and galactomannan are useful in suspected fungal infections and may reduce inappropriate antifungal use. Adrenomedullin and soluble triggering receptor on myeloid cells‐1 may be useful for mortality prediction and the determination of a need for empiric antibacterials. Although studies evaluating these biomarkers are promising, these biomarkers are not without limitations and should be used in combination with clinical signs, symptoms, or other biomarkers. For successful implementation of biomarker use, stewardship programs should consider the populations most likely to benefit, without using them indiscriminately in all patients. Antimicrobial stewardship programs should facilitate education of clinicians through institutional guidelines to ensure the appropriate use and interpretation of these biomarkers.

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“…Direct comparisons of the performance characteristics of the CDC/NHSN, CPIS, HELICS, and Johanson criteria have not previously been reported. Moreover, only two studies were identi ed that compared VAP diagnostic algorithms [32,66]. HELICS was chosen as the reference standard due as it has been reported to have the best performance characteristics, is widely used internationally, and has been used as the reference standard for numerous other studies [2,[44][45][46][47].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

Rahimi–Bashar

Miller²,

Yaghoobi

et al. 2020

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

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Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia

Cited by 23 publications

References 15 publications

The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia

The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia

Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

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