Journal of Critical Care
Volume 25, Issue 1 , Pages 62-68, March 2010

Accuracy of clinical definitions of ventilator-associated pneumonia: Comparison with autopsy findings

  • Eva Tejerina, MD, PhD

      Affiliations

    • Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, kilómetro 12.5, 28905 Getafe (Madrid), Spain
    • Corresponding Author InformationCorresponding author. Tel.: +34 91 6834982; fax: +34 91 6832095.
  • ,
  • Andrés Esteban, MD, PhD

      Affiliations

    • Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, kilómetro 12.5, 28905 Getafe (Madrid), Spain
    • CIBER Enfermedades Respiratorias, Instituto Carlos III, (Madrid), Spain
  • ,
  • Pilar Fernández-Segoviano, MD, PhD

      Affiliations

    • Pathology Unit, Hospital Universitario de Getafe, Carretera de Toledo, 28905 Getafe (Madrid), Spain
  • ,
  • Fernando Frutos-Vivar, MD

      Affiliations

    • Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, kilómetro 12.5, 28905 Getafe (Madrid), Spain
    • CIBER Enfermedades Respiratorias, Instituto Carlos III, (Madrid), Spain
  • ,
  • José Aramburu, MD

      Affiliations

    • Pathology Unit, Hospital Universitario de Getafe, Carretera de Toledo, 28905 Getafe (Madrid), Spain
  • ,
  • Daniel Ballesteros, MD

      Affiliations

    • Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, kilómetro 12.5, 28905 Getafe (Madrid), Spain
  • ,
  • José María Rodríguez-Barbero, MD

      Affiliations

    • Pathology Unit, Hospital Universitario de Getafe, Carretera de Toledo, 28905 Getafe (Madrid), Spain

published online 10 July 2009.

Abstract 

Methods

We studied patients requiring mechanical ventilation for more than 48 hours who died in the intensive care unit and whose bodies were autopsied. We evaluated 3 clinical definitions of ventilator-associated pneumonia: loose definition, defined as chest radiograph infiltrates and 2 of 3 clinical criteria (leukocytosis, fever, purulent respiratory secretions); rigorous definition, defined as chest radiograph infiltrates and all of the clinical criteria; and a clinical pulmonary infection score higher than 6 points. Sensitivity, specificity, and likelihood ratios were calculated by using pathology pattern as criterion standard.

Results

One hundred forty-two (56%) of the 253 patients included had histological criteria of pneumonia. Patients who met the clinical criteria of ventilator-associated pneumonia were 163 (64%) for the loose definition, 32 (13%) for the rigorous definition, and 109 (43%) for the clinical pulmonary infection score. The operative indexes (sensitivity and specificity) of each definition were as follows: loose definition, 64.8% and 36%; rigorous definition, 91% and 15.5%; and clinical pulmonary infection score higher than 6, 45.8% and 60.4%. The addition of microbiological data to the clinical definitions increased the specificity and decreased the sensitivity but not significantly.

Conclusions

Accuracy of 3 commonly used clinical definitions of ventilator-associated pneumonia was poor taking the autopsy findings as reference standard.

Keywords: Ventilator-associated pneumonia, Clinical diagnosis, Microbiological cultures, Radiographic infiltrates, Autopsy findings

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PII: S0883-9441(09)00121-X

doi:10.1016/j.jcrc.2009.05.008

Journal of Critical Care
Volume 25, Issue 1 , Pages 62-68, March 2010