Diagnosis of ventilator-associated pneumonia in critically ill adult patients-a systematic review and meta-analysis.

Adult Bronchoalveolar Lavage Bronchoalveolar Lavage Fluid Critical Illness Humans Pneumonia, Ventilator-Associated / diagnosis Respiration, Artificial Sensitivity and Specificity
Critical care Mechanical ventilation Nosocomial infections Ventilator-associated pneumonia

Journal

Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851

Informations de publication

Date de publication:
06 2020
Historique:
received: 14 02 2020
accepted: 02 04 2020
pubmed: 20 4 2020
medline: 28 4 2021
entrez: 20 4 2020
Statut: ppublish

Résumé

The accuracy of the signs and tests that clinicians use to diagnose ventilator-associated pneumonia (VAP) and initiate antibiotic treatment has not been well characterized. We sought to characterize and compare the accuracy of physical examination, chest radiography, endotracheal aspirate (ETA), bronchoscopic sampling cultures (protected specimen brush [PSB] and bronchoalveolar lavage [BAL]), and CPIS > 6 to diagnose VAP. We searched six databases from inception through September 2019 and selected English-language studies investigating accuracy of any of the above tests for VAP diagnosis. Reference standard was histopathological analysis. Two reviewers independently extracted data and assessed study quality. We included 25 studies (1639 patients). The pooled sensitivity and specificity of physical examination findings for VAP were poor: fever (66.4% [95% confidence interval [CI]: 40.7-85.0], 53.9% [95% CI 34.5-72.2]) and purulent secretions (77.0% [95% CI 64.7-85.9], 39.0% [95% CI 25.8-54.0]). Any infiltrate on chest radiography had a sensitivity of 88.9% (95% CI 73.9-95.8) and specificity of 26.1% (95% CI 15.1-41.4). ETA had a sensitivity of 75.7% (95% CI 51.5-90.1) and specificity of 67.9% (95% CI 40.5-86.8). Among bronchoscopic sampling methods, PSB had a sensitivity of 61.4% [95% CI 43.7-76.5] and specificity of 76.5% [95% CI 64.2-85.6]; while BAL had a sensitivity of 71.1% [95% CI 49.9-85.9] and specificity of 79.6% [95% CI 66.2-85.9]. CPIS > 6 had a sensitivity of 73.8% (95% CI 50.6-88.5) and specificity of 66.4% (95% CI 43.9-83.3). Classic clinical indicators had poor accuracy for diagnosis of VAP. Reliance upon these indicators in isolation may result in misdiagnosis and potentially unnecessary antimicrobial use.

Identifiants

DOI: 10.1007/s00134-020-06036-z PMID: 32306086 PMC: PMC7223448
pubmed: 32306086
doi: 10.1007/s00134-020-06036-z
pii: 10.1007/s00134-020-06036-z
pmc: PMC7223448
doi:

Types de publication

Journal Article Meta-Analysis Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1170-1179

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Références

Intensive Care Med. 1996 May;22(5):387-94
pubmed: 8796388
JAMA. 2018 Oct 9;320(14):1433-1434
pubmed: 30242350
Am Rev Respir Dis. 1984 Nov;130(5):924-9
pubmed: 6497170
Am J Respir Crit Care Med. 2011 Nov 15;184(10):1133-9
pubmed: 21852541
Intensive Care Med. 2020 May;46(5):888-906
pubmed: 32157357
Crit Care Med. 2018 Jan;46(1):71-78
pubmed: 29053492
Chest. 2008 Aug;134(2):281-287
pubmed: 18682456
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
Surg Infect (Larchmt). 2014 Dec;15(6):739-44
pubmed: 25314257
Ann Transl Med. 2017 Nov;5(22):450
pubmed: 29264367
Am J Respir Crit Care Med. 2010 Dec 15;182(12):1533-9
pubmed: 20693381
JAMA. 2007 Apr 11;297(14):1583-93
pubmed: 17426278
BMJ Open Respir Res. 2014 Dec 16;1(1):e000066
pubmed: 25553248
J Clin Epidemiol. 2011 Apr;64(4):401-6
pubmed: 21208779
Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1982-91
pubmed: 8520766
Thorax. 2017 Nov;72(11):1046-1048
pubmed: 27974525
Chest. 1992 Feb;101(2):458-63
pubmed: 1735272
Ann Intern Med. 2008 Dec 16;149(12):889-97
pubmed: 19075208
Lancet Infect Dis. 2013 Aug;13(8):665-71
pubmed: 23622939
J Crit Care. 2008 Mar;23(1):91-100
pubmed: 18359426
Curr Opin Infect Dis. 2008 Apr;21(2):157-62
pubmed: 18317039
Eur Respir J. 2000 Nov;16(5):969-75
pubmed: 11153601
Intensive Care Med. 2010 May;36(5):790-8
pubmed: 20217042
JAMA. 2018 Jan 23;319(4):388-396
pubmed: 29362800
Intensive Care Med. 2020 Feb;46(2):225-235
pubmed: 31996961
Thorax. 1999 Oct;54(10):867-73
pubmed: 10491448
Ann Intern Med. 2011 Oct 18;155(8):529-36
pubmed: 22007046
Am J Respir Crit Care Med. 1995 Jun;151(6):1878-88
pubmed: 7767535
Crit Care. 2008;12(2):R56
pubmed: 18426596
Anesthesiology. 1996 Apr;84(4):760-71
pubmed: 8638829
J Crit Care. 2016 Jun;33:151-7
pubmed: 26993370
J Crit Care. 2010 Mar;25(1):62-8
pubmed: 19592209
Allergy. 2009 Aug;64(8):1109-16
pubmed: 19489757
Am J Emerg Med. 2013 Feb;31(2):401-5
pubmed: 23083885
Intensive Care Med. 2004 Feb;30(2):217-224
pubmed: 14566455
Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):324-31
pubmed: 8306025
Am Surg. 1999 Sep;65(9):805-9; discussion 809-10
pubmed: 10484081
Chest. 1997 Aug;112(2):458-65
pubmed: 9266884
Am J Respir Crit Care Med. 2002 Apr 1;165(7):867-903
pubmed: 11934711
Chest. 2015 Feb;147(2):347-355
pubmed: 25340476
Intensive Care Med. 2004 May;30(5):844-52
pubmed: 15127196
Ann Intern Med. 2000 Apr 18;132(8):621-30
pubmed: 10766680
Braz J Med Biol Res. 2001 Aug;34(8):993-1001
pubmed: 11471037
Crit Care Med. 2013 Nov;41(11):2467-75
pubmed: 24162674
Chest. 1997 Aug;112(2):445-57
pubmed: 9266883
Crit Care Med. 2000 Aug;28(8):2799-804
pubmed: 10966253
N Engl J Med. 2019 Nov 7;381(19):1831-1842
pubmed: 31693806
Ann Intern Med. 2018 Feb 20;168(4):266-275
pubmed: 29404582
Am J Respir Crit Care Med. 2015 Oct 15;192(8):974-82
pubmed: 26168322
Anesthesiology. 1989 Nov;71(5):679-85
pubmed: 2817462
Chest. 1988 Feb;93(2):318-24
pubmed: 3338299
BMJ. 2019 Jul 24;366:l4225
pubmed: 31340932
Am J Respir Crit Care Med. 1995 Jul;152(1):231-40
pubmed: 7599829
Lancet Infect Dis. 2012 Oct;12(10):774-80
pubmed: 22951600
Am J Respir Crit Care Med. 2003 Jul 15;168(2):173-9
pubmed: 12738607
Crit Care. 2014 Aug 13;18(5):480
pubmed: 25405992
Stat Med. 2001 Oct 15;20(19):2865-84
pubmed: 11568945
Infect Control Hosp Epidemiol. 2014 Mar;35(3):278-84
pubmed: 24521594
J Burn Care Res. 2007 Jan-Feb;28(1):76-9
pubmed: 17211204
Chest. 1981 Sep;80(3):254-8
pubmed: 7273874
J Clin Epidemiol. 2008 Aug;61(8):755-62
pubmed: 18586179
Am Rev Respir Dis. 1991 May;143(5 Pt 1):1121-9
pubmed: 2024824

Auteurs

Shannon M Fernando (SM)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.

Alexandre Tran (A)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.

Wei Cheng (W)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Michael Klompas (M)

Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.

Kwadwo Kyeremanteng (K)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Sangeeta Mehta (S)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Sinai Health System, Toronto, ON, Canada.

Shane W English (SW)

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

John Muscedere (J)

Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Deborah J Cook (DJ)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Antoni Torres (A)

Department of Pulmonary and Critical Care Medicine, Hospital Clinic Barcelona, Barcelona, Spain.
Faculty of Medicine, University of Barcelona, Barcelona, Spain.

Otavio T Ranzani (OT)

Pulmonary Division, Heart Institute, Universidade de Sao Paulo, São Paulo, Brazil.
Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.

Alison E Fox-Robichaud (AE)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.

Waleed Alhazzani (W)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Laveena Munshi (L)

Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Sinai Health System, Toronto, ON, Canada.

Gordon H Guyatt (GH)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.

Bram Rochwerg (B)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › Techniques d'investigation › Irrigation thérapeutique › Lavage bronchoalvéolaire › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › Techniques d'investigation › Irrigation thérapeutique › Lavage bronchoalvéolaire › Liquide de lavage bronchoalvéolaire › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie iatrogène › Infection croisée › Pneumonie associée aux soins › Pneumopathie infectieuse sous ventilation assistée › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Diagnosis of ventilator-associated pneumonia...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Sensibilité et spécificité › Diagnosis of ventilator-associated pneumonia...