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Methodology for Clinical Investigation of Ventilator-Associated Pneumonia: Epidemiology and Therapeutic Intervention

Published online by Cambridge University Press:  21 June 2016

Richard G. Wunderink ,
C. Glen Mayhall  and
Claude Gibert
Richard G. Wunderink
Affiliation:
Divisions of Pulmonary and Critical Care Medicine and Infectious Diseases, The University of Tennessee, Memphis; Hospital Bichat, Paris, France
C. Glen Mayhall
Affiliation:
Divisions of Pulmonary and Critical Care Medicine and Infectious Diseases, The University of Tennessee, Memphis; Hospital Bichat, Paris, France
Claude Gibert
Affiliation:
Divisions of Pulmonary and Critical Care Medicine and Infectious Diseases, The University of Tennessee, Memphis; Hospital Bichat, Paris, France
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Extract

We now have the ability to accurately diagnose ventilator-associated pneumonia (VAP), which should lead to re-examination of nondiagnostic aspects of VAP Previous data regarding the epidemiology, treatment, and prevention of VAP were derived almost exclusively from studies in which the diagnoses were based on clinical criteria and cultures of endotracheal aspirates. These criteria are inaccurate in as many as 60 percent of cases compared to autopsy or quantitative cultures of bronchoscopic specimens. Many recent studies of VAP have focused on the accuracy of bronchoscopic and other methods of obtaining uncontaminated specimens from the lower respiratory tract for diagnosis. In anticipation of the use of these more accurate techniques to validate conclusions derived from studies based on the clinical diagnosis of VAP, the appropriateness of the design and conclusions of these published studies have been reviewed. In this communication, we discuss the areas in which sufficient data exist to reach consensus regarding methods for future studies in the epidemiology, treatment, and prevention of VAP and also attempt to delineate areas for future research endeavors.

Type
Proceedings of the First International Consensus Conference on the Clinical Investigation of Ventilator-Associated Pneumonia
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 11 , November 1992 , pp. 667 - 677
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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References

1. Rothman, KJ. Modern Epidemiology. Boston, Ma: Little, Brown and Company; 1986.Google Scholar
2. Andrews, CR, Coalson, JJ, Smith, JD, et al. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest. 1981;80:254–258.Google Scholar
3. Meduri, GU. Ventilator-associated pneumonia in patients with respiratory failure: diagnostic approach. Chest. 1990;97:1208–1219.Google Scholar
4. Fagon, J, Chastre, J, Hance, AJ, et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Reu Respir Dis. 1988;138:110–116.Google Scholar
5. Bell, RC, Coalson, JJ, Johanson, WG Jr. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983;99:293–298.Google Scholar
6. DeCastro, FR, Violan, JS, Capuz, BL, et al. Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients. Crit Cure Med. 1991;19:171–175.Google Scholar
7. Anonymous. Nosocomial infection rates for interhospital comnarison: limitations and possible solutions. Infect Control Hosp Epidemiol. 1991;12:609–621.Google Scholar
8. Knaus, WA, Zimmerman, JE, Wagner, DP, et al. APACHE = macute physiology and chronic health evaluation: a physiologically based classification system. Crit Cure Med. 1981;9:591–597.CrossRefGoogle Scholar
9. Knaus, WA, Draper, EA, Wagner, DP, et al. APACHE II: a severity of disease classification system. Crit Cure Med. 1985;13:818–829.Google Scholar
10. LeGall, JR, Loirat, P, Alperovitch, A, et al. A simplified acute physiology score for ICU patients. Crit Cure Med. 1984;12:975–977.Google Scholar
11. Gross, PA, Beyt, BE Jr, Decker, MD, et al. Description of casemix adjusters by the severity of illness working group of the Society of Hospital Epidemiologists of American (SHEA). Infect Control Hosp Epidemiol 1988;9:309–316.CrossRefGoogle Scholar
12. Chang, RWS, Jacobs, S, Lee, B, et al. Predicting deaths among intensive care unit patients. Crit Cure Med. 1988;16:34–42.CrossRefGoogle ScholarPubMed
13. Knaus, WA, Wagner, DP, Draper, EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–1636.Google Scholar
14. Lemeshow, S, Tferes, D, Pastides, H, et al. A method for predicting survival and mortality of ICU patients using objectively derived weights. Crit Cure Med. 1985;13:519.CrossRefGoogle ScholarPubMed
15. Cullen, DJ, Civetta, JM, Briggs, BA, et al. Therapeutic intervention scoring system: a method for quantitative comparison of patient care . Crit Cure Med. 1984;2:57.CrossRefGoogle Scholar
16. Keene, AR Cullen, DJ. Therapeutic Intervention Scoring System: update. 1983. Crit Cure Med. 1983;11:1–3.Google Scholar
17. Gross, PA, Stein, MR, van Antwerpen, C, et al. Comparison of severity of illness indicators in an intensive care unit. Arch Intern Med. 1991;151:2201–2205.Google Scholar
18. Owens, WD, Felts, JA Spitznagel, EL. ASA physical status classification: a study of consistency of ratings. Anesthesiology. 1978;49:239–243.CrossRefGoogle ScholarPubMed
19. McCabe, WR, Jackson, GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med. 1962;110:83–91.CrossRefGoogle Scholar
20. Langer, M, Mosconi, P, Cigada, M, et al. Long-term respiratory support and risk of pneumonia in critically ill patients. Am Rev Respir Dis. 1989;140:302–305.Google Scholar
21. Craven, DE, Kunches, LM, Kilinsky, V, et al. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis. 1986;133:792–796.Google ScholarPubMed
22. Celis, R, Torres, A, Gatel, JM 11, et al. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest. 1988;93:318–374.Google Scholar
23. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis. 1990;142:523–528.Google Scholar
24. Fagon, J, Chastre, J, Domart, Y, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989;139:877–884.CrossRefGoogle ScholarPubMed
25. Niedennan, MS, Mantovani, R, Schoch, P, et al. Patterns and routes of tracheobronchial colonization in mechanically ventilated patients. Chest. 1989:95:155–161.Google Scholar
26. Chow, JW, Fine, MJ, Shlaes, DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therarjy. Ann Intern Med. 1991:115:585–590.Google Scholar
27. Leu, H, Kaiser, DL, Mori, M, et al. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol. 1989;29 1258–1267.Google Scholar
28. Silver, DR, Cohen, IL, Weinberg, PE Recurrent Pseudomonas aeruginosa pneumonia in an intensive care unit. Chest. 1992;101:194–198.Google Scholar
29. Chow, AW, Hall, CB, Klein, JO, et al. Evaluation of new anti infective drugs for the treatment of respiratory tract infections. Rev Infect Dis. In press.Google Scholar
30. Knaus, WA, Wagner, DE Multiple systems organ failure: epidemiology and prognosis. Crit Cure Clin. 1989;5:81–87.Google Scholar
31. Pugin, J, Aukenthaler, R, Mili, N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” 8221; bronchoalveolar lavage. Am Rev Respir Dis. 1991;143:1121–1129.CrossRefGoogle Scholar
32. Solomkin, JS, Dellinger, EP, Christou, NV, et al. Design and conduct of antibiotic trials: a report of the Scientific Studies Committee of the Surgical Infection Society. Arch Surg. 1987;18:158–164.CrossRefGoogle Scholar
33. Solomkin, JS, Dellinger, EP, Christou, NV, et al. Results of a multicenter trial comparing imipenem/cilastin to tobramycin/clindamycin for intra-abdominal infections. Ann Surg. 1990;212:581–591.Google Scholar
34. Shenep, JL, Barton, RP Mogan, KA. Role of antibiotic class in the rate of liberation of endotoxin during therapy for experimental Gram-negative sepsis. J Infect Dis. 1985;151:1012–1018.Google Scholar
35. Baughman, RP, Thorpe, JE, Staneck, J, et al. Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. Chest. 1987;91:233–235.Google Scholar
36. Fox, RC, Williams, CJ, Wunderink, RG, et al. Follow-up bronchoscopy predicts therapeutic outcome in ventilated patients with nosocomial pneumonia. Am Rev Respir Dis. 1991;143:109.Google Scholar
37. Blavia, R, Dorca, J, Verdaguer, R, et al. Bacteriological follow-up of nosocomial pneumonia by successive protected specimen brush. Eur Respir J 1991;4(suppl):407S.Google Scholar