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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