Skip to main content

Table 1 Clinical criteria used in diagnosing ventilator-associated pneumonia

From: Diagnosis of ventilator-associated pneumonia: a systematic review of the literature

Johanson criteria • Presence of a new or progressive radiographic infiltrate
  • Plus at least two of three clinical features:
     - fever > 38°C
     - leukocyto sis or leukopeni
     - purulent secretions
  • Temperature • Oxygenation (PaO2/FiO2) • Tracheal secretions (score)
  - 0 point: 36.5–38.4 C - 0 point: PaO2/FiO2 > 240 or ARDS -0 point: < 14
  - 1 point: 38.5–38.9 - 2 points: PaO2/FiO2 < 240 and no evidence of ARDS -1 point: > 14
  - 2 points: < 36 or > 39   -2 points: purulent sputum
Clinical Pulmonary Infection Score (CPIS) • Blood leukocytes (cells/μL)   • Culture of tracheal aspirate
  - 0 point: 4000–11000   -0 point: minimal or no growth
  - 1 point: < 4000 or > 11000   -1 point: moderate or more growth
  - 2 points: > 500 band forms   -2 points: moderate or greater growth
   • Pulmonary radiography  
   -0 point: no infiltrate  
   - 1 point: diffuse or patchy infiltrates  
   - 2 points: localized infiltrate  
  Total score of > 6 points suggests ventilator-associated pneumonia
  ARDS = acute respiratory distress syndrome
Centers for Disease Control and Prevention (CDC) • Radiology signs • Clinical signs  
  Two or more serial chest radiographs with at least 1 of the following: At least 1 of the following:  
  - new or progressi ve and persistent infiltrate - fever (temperat ure > 38 C)  
  - consolidation - leukopeni a (< 4000 WBC) or leukocyto sis (> 12000 WBC)  
  - cavitation - altered mental status, for adults 70 years or older, with no other recognized cause  
  • Microbiological criteria   
  At least one of the following: Plus at least 2 of the following:-  
  - positive growth in blood culture not related to another source of infection - new onset of purulent sputum, or change in character of sputum  
  - positive growth in culture or pleural field - increased respiratory secretions, or increased suctioning requirements  
  - positive quantitati ve culture from bronchoal veolar lavage (> 104) or protected specimen brushing (> 103) - new-onset or worsening cough, or dyspnea, or tachypnea  
  - five percent or more of cells with intracellul ar bacteria on direct microsco pic examinati on of Gram-stained bronchoal veolar lavage fluid - rales or bronchial sounds  
  - histopathological evidence of pneumonia - worsening gas exchange  
   - increased oxygen requirements