Wednesday September 13, 2006
VAP and CPIS


Q; This is a very common scenario in ICUs. You have an intubated patient who starts having low grade fever and increase secretion through respiratorty tract. CXR has mild infiltrate. You suspect Ventilator-associated pneumonia (VAP) and started emperic antibiotic. Indeed, patient is showing signs of improvement in next 2/3 days but LRT (lower respiratory tract) specimen, blood cultures and UA remained negative. CXR unchanged. No other source of infection apparent. What would be your next step ?


A; Consider stopping antibiotics.

If patient's clinical pulmonary infection score (CPIS) - click here to see - remained 6 (maximum 12) or less for three days in suspected VAP - consideration should be given to stop antibiotics 1.

Click here to see one algorithm proposed by Dr. Singh and co. from Veterans Affairs Medical Center and University of Pittsburgh, Pittsburgh, Pennsylvania 2.


References: click to get abstract / article

1. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia - American Thoracic Society
2. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000;162:505–511
3. Ventilator-associated Pneumonia - Am. J. Respir. Crit. Care Med., Volume 165, Number 7, April 2002, 867-903
4. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121–1129.