Ventilator-Associated Pneumonia (VAP): Are we ready to let go of the old definitions

Abstract

Background: In 2013 the NHSH implemented major changes in the VAP definition. Reviewing episodes became easier and faster and it eliminated most of the subjective interpretation of data. We started implementing this new definition in January 2017 but continued to use the old definition as well. Objectives: Assess the impact of the new NHSN definitions to calculate the VAP rates in our hospital. Analyze whether the changes in the VAP rates trends are reflected in antibiotic consumption. Methods & Materials: Descriptive Study. Retrospective analysis of the VAP rates in Intensive Care Unit (ICU) and Coronary Care Unit (CCU). Daily data from active surveillance, microbiology reports and electronic medical records review. Antibiotic consumption in ICU and CCU: DDD Defined Daily Dose. D/P: every 100 days/patient Results: VAP Rates (per1000 days ventilator) 2013-2016 old definition and 2017 old and new definition. ICU: 2013: 4.02, 2014 6.27 2015 3.42, 2016 4.12 2017 old 2.65, new:0. CCU: 2013: 12.41, 2014 9.9, 2015 10.23, 2016: 8, 2017 old: 2.8 new: 0. Antibiotic consumption: CCU DDD 2016 D/P 27.4, 2017 39.09. ICU DDD 2016 D/P 91,39 2017 95.43. We observed a statistically significant increase in antibiotic consumption in the ICC from 2016 to 2017(p ≤ 0.001). In the ICU there was there was no significant decrease in antibiotic consumption, with a tendency to rise for this period. Conclusion: Although we observed a decreasing tendency in VAP these years, the abrupt fall in VAP rates after the introduction of the new NHSN definitions seems to reflect a definition biass more than an improvement in the care provided to our patients.We have observed no significant change in antibiotic use to match the changes in VAP rates.It can be a big risk to use a definition that gives us a false sense of security, leading us to more relaxed behaviour in terms of prevention. For the time being, we consider useful to use both definitions to calculate VAP rates and dentify this risk.