Volume 19 Supplement 2
Comparing CDC's surveillance definitions and CPIS score in diagnosing ventilator-associated pneumonia: an observational study
© Koenig et al. 2015
Published: 28 September 2015
The National Healthcare Safety Network/Center for Disease Control and Prevention (NHSN/CDC) published in 2013 a new surveillance protocol in order to standardize the ventilator-associated pneumonia (VAP) confirmation criteria and, consequently, to increase the reliability of indicators in different institutions.
To evaluate the degree of agreement of CDC's new surveillance definitions and clinical criteria, using the CPIS score, in diagnosing VAP.
From August 2013 to June 2014 all patients on mechanical ventilation for longer than 48 hours in two critical care units in a public and a private general hospital were included in the study. On a daily basis, ventilated patients were evaluated by respiratory physiotherapists using the CPIS score and, independently, by the infection preventionist nurse using CDC's new surveillance definitions. CPIS score = 7 was considered a clinical diagnosis, and, when associated with a semiquantitative culture with 104 colony-forming units, as a definitive diagnosis of VAP.
Eight hundred and one patients were admitted to both ICUs during the study period. One hundred and sixty-eight were on mechanical ventilation for more than 48 hours. Thirty-eight patients were diagnosed with pneumonia using the clinical criteria (13.8/1000 patients/day on ventilation). Eighteen of these patients were diagnosed with infectious conditions associated with mechanical ventilation (IVAC) and 14 of them had a diagnosis of probable VAP (5.23/1000 patients/day on ventilation). Compared with clinical criteria, the CDC's surveillance definitions had sensitivity = 0.37, specificity = 1.0, positive predictive value = 1.0 and negative predictive value = 0.84.
Compared with clinical criteria, using the CPIS score, the CDC's new surveillance definitions had a low sensitivity and may not be appropriate as a surveillance method.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.