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 |
| Â | - 2 points: < 36 or > 39 | Â | -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 |
| Â | - 1 point: < 4000 or > 11000 | Â | -1 point: moderate or more growth |
| Â | - 2 points: > 500 band forms | Â | -2 points: moderate or greater growth |
|  |  | • Pulmonary radiography |  |
| Â | Â | -0 point: no infiltrate | Â |
| Â | Â | - 1 point: diffuse or patchy infiltrates | Â |
| Â | Â | - 2 points: localized infiltrate | Â |
| Â | Total score of > 6 points suggests ventilator-associated pneumonia | ||
| Â | ARDS = acute respiratory distress syndrome | ||
Centers for Disease Control and Prevention (CDC) | • Radiology signs | • Clinical signs |  |
| Â | Two or more serial chest radiographs with at least 1 of the following: | At least 1 of the following: | Â |
| Â | - new or progressi ve and persistent infiltrate | - fever (temperat ure > 38 C) | Â |
| Â | - consolidation | - leukopeni a (< 4000 WBC) or leukocyto sis (> 12000 WBC) | Â |
| Â | - cavitation | - altered mental status, for adults 70 years or older, with no other recognized cause | Â |
|  | • Microbiological criteria |  |  |
| Â | At least one of the following: | Plus at least 2 of the following:- | Â |
| Â | - positive growth in blood culture not related to another source of infection | - new onset of purulent sputum, or change in character of sputum | Â |
| Â | - positive growth in culture or pleural field | - increased respiratory secretions, or increased suctioning requirements | Â |
| Â | - positive quantitati ve culture from bronchoal veolar lavage (> 104) or protected specimen brushing (> 103) | - new-onset or worsening cough, or dyspnea, or tachypnea | Â |
| Â | - 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 | Â |
| Â | - histopathological evidence of pneumonia | - worsening gas exchange | Â |
| Â | Â | - increased oxygen requirements | Â |