Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia

Alexandre Gaudet,Ignacio Martin-Loeches,Alain Duhamel,Pedro Povoa,Alejandro Rodriguez,Saad Nseir,Jorge Salluh

doi:10.1186/s13613-020-00721-4

Abstract

BackgroundDifferentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. In this study, we evaluated the accuracy of the Clinical Pulmonary Infection Score (CPIS) to differentiate VAT and VAP.MethodsWe performed a retrospective analysis based on the data from 2 independent prospective cohorts. Patients of the TAVeM database with a diagnosis of VAT (n = 320) or VAP (n = 369) were included in the derivation cohort. Patients admitted to the Intensive Care Centre of Lille University Hospital between January 1, 2016 and December 31, 2017 who had a diagnosis of VAT (n = 70) or VAP (n = 139) were included in the validation cohort. The accuracy of the CPIS to differentiate VAT from VAP was assessed within the 2 cohorts by calculating sensitivity and specificity values, establishing the ROC curves and choosing the best threshold according to the Youden index.ResultsThe areas under ROC curves of CPIS to differentiate VAT from VAP were calculated at 0.76 (95% CI [0.72–0.79]) in the derivation cohort and 0.67 (95% CI [0.6–0.75]) in the validation cohort. A CPIS value ≥ 7 was associated with the highest Youden index in both cohorts. With this cut-off, sensitivity and specificity were respectively found at 0.51 and 0.88 in the derivation cohort, and at 0.45 and 0.89 in the validation cohort.ConclusionsA CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts.

Highlights

Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs
Three hundred twenty patients with VAT and 369 patients with VAP were included in the derivation cohort
Appropriate initial antimicrobial therapy was more frequent in VAP than in VAT in the derivation cohort, and less frequent in VAP compared to VAT in the validation cohort (Table 1)

Summary

Introduction

Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. Ventilator-Associated Lower Respiratory Tract Infections (VA-LRTI), including Ventilator-Associated Tracheobronchitis (VAT) and Ventilator-Associated Pneumonia (VAP), are the most frequent infectious complications in Intensive Care Units (ICU), concerning about 25% of critically ill subjects undergoing mechanical ventilation [1]. Their diagnosis currently relies on symptoms of lower respiratory tract infection in patients intubated for more than 48 h with a positive culture of lower respiratory microbiological sampling. The Gaudet et al Ann. Intensive Care (2020) 10:101 diagnosis of VAT seems to be linked with lower levels of mortality than VAP, even though being associated with increased length of mechanical ventilation and ICU stay [1]. The management of VAP currently relies on antimicrobial therapy, whereas current guidelines do not recommend the administration of antibiotics in VAT, making the distinction between these two entities a crucial point [2]

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