PURPOSE: Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection in Intensive Care Unit (ICU) patients and has been associated with increased morbidity, prolonged duration of ventilation and ICU-stay, and increased costs for health care. The Clinical Pulmonary Infection Score (CPIS), a diagnostic algorithm that relies on easily available clinical, radiographic, and microbiological criteria, is used for diagnosing VAP. The aim of this study was to assess the prognostic value of the CPIS on day 1 (CPIS1) and day 3 (CPIS3) and to assess the modification of antibiotics on 28 day mortality.
METHODS: We conducted a retrospective observational study between January 2005 and April 2006 in our tertiary care facility, including patients suspected of having VAP. Data collection included: CPIS1, CPIS3, antibiotics started on day 1, antibiotics appropriately modified on day 3 and 28 day mortality. Relationships were examined using Chi-Square statistic with p < 0.05 as significant. This study was approved by our University Institutional Review Board.
RESULTS: Ninety two patients were studied. They had a mean age of 56.4 years; 47 were males. CPIS1 was <6 in 46/92 = 50% of patients and ≥6 in 46. CPIS3 was <6 in only 25/92 = 27% and ≥6 in 67/92 = 73% of patients. There was no statistically significant relationship between CPIS1 and CPIS3. Antibiotics were administered on day 1 in 82 patients and were modified on day 3 in 42/92 = 45.7% of patients. Mortality occurred in 29/92 = 31.5% of patients; there was no statistically significant relationship to CPIS1, CPIS3, or modification of antibiotics.
CONCLUSION: A CPIS3 <6 reduced the diagnosis of VAP. CPIS3 resulted in modification of antibiotics in 45.7% of patients. CPIS1, CPIS3 and modification of antibiotics had no statistically significant relationship with mortality.
CLINICAL IMPLICATIONS: CPIS remains a desirable guide for diagnosis of VAP but CPIS1, CPIS3 and modification of antibiotics should not be used for predicting prognosis.
DISCLOSURE: Ghulam Khaleeq, None.