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Ventilator-associated pneumonia surveillance using two methods

Craven, T. H.; Wojcik, G.; McCoubrey, J.; Brooks, O.; Grant, E.; Keating, S.; Reilly, J.; Laurenson, I. F.; Kefala, K.; Walsh, T. S.

Authors

T. H. Craven

J. McCoubrey

O. Brooks

E. Grant

S. Keating

J. Reilly

I. F. Laurenson

K. Kefala

T. S. Walsh



Abstract

Background
Ventilator-associated pneumonia surveillance is used as a quality indicator due to concerns that some cases may be preventable and may contribute to mortality. Various surveillance criteria exist for the purposes of national reporting, but a large-scale direct comparison has not been conducted.

Methods
A prospective cohort study applied two routinely used surveillance criteria for ventilator-associated pneumonia from the European Centre for Disease Control and the American Centers for Disease Control to all patients admitted to two large general intensive care units. Diagnostic rates and concordance amongst diagnostic events were compared.

Findings
A total of 713 at-risk patients were identified during the study period. The European surveillance algorithm returned a rate of 4.6 cases of ventilator-associated pneumonia per 1000 ventilation days (95% confidence interval 3.1–6.6) and the American surveillance system a rate of 5.4 (3.8–7.5). The concordance between diagnostic events was poor (Cohen's Kappa 0.127 (-0.003 to 0.256)).

Conclusions
The algorithms yield similar rates, but the lack of event concordance reveals the absence of inter-algorithm agreement for diagnosing ventilator-associated pneumonia, potentially undermining surveillance as an indicator of care quality.

Citation

Craven, T. H., Wojcik, G., McCoubrey, J., Brooks, O., Grant, E., Keating, S., …Walsh, T. S. (2020). Ventilator-associated pneumonia surveillance using two methods. Journal of Hospital Infection, 104(4), 522-528. https://doi.org/10.1016/j.jhin.2020.01.020

Journal Article Type Article
Acceptance Date Jan 28, 2020
Online Publication Date Feb 5, 2020
Publication Date 2020-04
Deposit Date Jul 13, 2020
Journal Journal of Hospital Infection
Print ISSN 0195-6701
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 104
Issue 4
Pages 522-528
DOI https://doi.org/10.1016/j.jhin.2020.01.020
Keywords ventilator-associated pneumonia, Infection surveillance, Mechanical ventilation, Critical care
Public URL http://researchrepository.napier.ac.uk/Output/2674954


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