What are the IDSA/ATF recommendations for the diagnosis of ventilator-associated pneumonia (VAP)?

Updated: Jul 30, 2018
  • Author: Burke A Cunha, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Answer

Obtaining sputum via noninvasive methods with semiquantitative cultures is preferred over invasive techniques with quantitative cultures or noninvasive approaches with quantitative cultures. Noninvasive techniques include collection of spontaneously expectorated samples, sputum production, and nasotracheal suctioning. Endotracheal aspiration in a patient with VAP is considered noninvasive. Invasive approaches include bronchoalveolar lavage, protected specimen brush, and blind bronchial sampling.

Biomarkers, such as procalcitonin, soluble triggering receptor expressed on myeloid cells (obtained via bronchoalveolar lavage), or C-reactive protein combined with clinical criteria should not be used to diagnose HAP/VAP. Such diagnoses should be based on clinical criteria alone. The biomarker procalcitonin (PCT) is usually unhelpful in the diagnosis of nosocomial pneumonia in ICU patients, who often have elevated PCT levels due to hypotension, renal failure, hepatic insufficiency, pancreatitis, drug reactions, or lung cancer, among others. [20, 21]

The use of the Modified Clinical Pulmonary Infection Score combined with clinical criteria should not be used to diagnose HAP/VAP. These diagnoses should be based on clinical criteria alone.


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