PURPOSE: The clinical pulmonary infection score (CPIS) was introduced as a diagnostic tool for VAP, which includes microbiological data into the clinical criteria for diagnosis. However, it cannot be used for screening VAP as culture results are not immediately available. The potential value of Gram stain examination of respiratory tract samples in this setting has been rarely assessed. Our study evaluated the clinical diagnosis of VAP based on the inclusion of Gram stain results of bronchoscoscopic and non-bronchoscopic samples into the modified clinical pulmonary infection score (m-CPIS = CPIS excluding culture data).
METHODS: Observational study including 100 first episodes of suspected pneumonia. We assessed the rates of correctly diagnosed episodes and of those treated empirically (i.e., ultimately confirmed pneumonia), or appropriately not receiving such therapy (non-confirmed pneumonia), based on culture results from samples obtained by bronchoscopy and non-bronchoscopic techniques.
RESULTS: A baseline mean m-CPIS was calculated for every patient with clinical suspicion for VAP and was 6.4 and 3.0 for culture positive and negative cases, respectively. Addition of Gram stain results to the baseline m-CPIS significantly increased the score in patients with positive quantitative cultures. The baseline mean m-CPIS of cases in which samples were obtained by bronchoscopy increased to 8.00 and 3.5 in VAP positive cases and negative cases, respectively (p<0.01). The algorithm incorporating gram stain data allowed early appropriate management in 80% of patients, including 85% of those with confirmed pneumonia, and 70% of those without confirmed infection. The empiric regimen was adequate in 86% of confirmed episodes.
CONCLUSION: Inclusion of Gram stain results into modified-CPIS may augment the diagnostic evaluation of VAP.
CLINICAL IMPLICATIONS: A management strategy based on Gram stains of respiratory tract secretion specimens allows rapid and correct identification of patients with suspected VAP needing or not needing initial empiric therapy.
DISCLOSURE: Alexander Panda, No Financial Disclosure Information; No Product/Research Disclosure Information