The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia

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Hapsari Widya Ningtiar
Dwi Putri Lestari
Neurinda Permata Kusumastuti
Arina Setyaningtyas
Retno Asih Setyoningrum
Ira Dharmawati
Abdul Latief Azis

Abstract

Background Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU), with mortality rates of up to 50%. Post-mortem pulmonary examination is considered to be the gold standard for diagnosis of VAP, but is impossible for routine application. The sensitivity and specificity of Clinical Pulmonary Infection Score (CPIS) are considered to be similar to the those of the gold standard, but the Centers for Disease Control and Prevention PNU-1 (CDC PNU-1) is simpler and not invasive, compared to the CPIS.


Objective To evaluate the level of agreement between CDC PNU-1 and CPIS criteria in diagnosing VAP.


Methods This cross-sectional study was conducted in the PICU at Dr. Soetomo Hospital, Surabaya from June to October 2018. Subjects were children aged 1 month–18 years who had been intubated for more than 48 hours. The VAP diagnoses were made by CDC PNU-1 and CPIS criteria. The level of agreement between the two methods was evaluated by Cohen’s Kappa test using SPSS Statistics Base 21.0 software.


Results hirty-six subjects were evaluated using CDC PNU-1 and CPIS criteria. Subjects’ mean age was 3.5 (SD 4.7) years. Amongst 19 patients with VAP, 14 were diagnosed by CPIS criteria and 17 were diagnosed by CDC PNU-1 criteria. The level of agreement between the CDC PNU-1 and CPIS criteria was good (Kappa 0.61; 95%CI 0.31 to 0.83). The CDC PNU-1 had sensitivity 0.85, specificity 0.77, positive predictive value (PPV) 0.70, and negative predictive value (NPV) 0.89.


Conclusion The CDC PNU-1 criteria has a good level of agreement with CPIS criteria in diagnosing VAP.

Article Details

How to Cite
1.
Ningtiar H, Lestari D, Kusumastuti N, Setyaningtyas A, Setyoningrum R, Dharmawati I, Azis A. The CDC PNU-1 criteria for diagnosis of ventilator-associated pneumonia. PI [Internet]. 14Aug.2019 [cited 18Oct.2019];59(4):195-01. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2188
Section
Emergency & Pediatric Intensive Care
Received 2019-04-24
Accepted 2019-08-14
Published 2019-08-14

References

1. Turton P. Ventilator-associated pneumonia in paediatric intensive care: a literature review. Nurs Crit Care. 2008;13:241-8.
2. Chang I, Schibler A. Ventilator associated pneumonia in children. Paediatr Respir Rev. 2016;20:10-6.
3. Aelami M, Lofti M, Zingg W. Ventilator-associated pneumonia in neonates, infants and children. Antimicrob Resist Infect Control. 2014;3:1-10.
4. Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis. 2010;51:S131-5.
5. Gupta S, Boville BM, Blanton R, Lukasiewica G, Wincek J, Bai C, et al. A multicentered prospective analysis of diagnosis, risk factors, and outcomes associated with pediatric ventilator-associated pneumonia. Pediatr Crit Care Med. 2015;16:e65-e73.
6. Rea-Neto A, Youssef NCM, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care. 2008;12:R56.
7. Balasubramanian P, Tullu MS. Study of ventilator-associated pneumonia in a pediatric intensive care unit. Indian J Pediatr. 2014;81:1182-6.
8. Pugin J. Clinical signs and scores for the diagnosis of ventilator-associated pneumonia. Minerva Anestesiol. 2002;68:261-5.
9. Center for Disease Control and Prevention. CDC/National Healthcare Safety Network Surveillance Definitions for Specific Types of Infections. Atlanta;CDC/NHSN;2014.p.17-9.
10. Joram N, de Saint Blanquat L, Stamm D, Launay E, Gras-Le Guen C. Healthcare-associated infection prevention in pediatric intensive care units: a review. Eur J Clin Microbiol Infect Dis. 2012;31:2481-90.
11. Dorofaef T, Mohseni-Bod H, Cox PN. Infections in the PICU. In: Elzouki, AY, Harfi HA, Nazer HM, Stapleton FB, Whitley RJ, editors. Textbook of clinical pediatrics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012. pp. 2537-63.
12. Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A, et al. Ventilator Associated pneumonia in a paediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol. 2004;25(9):753–58.
13. Elward AM, Warren DK, Fraser VJ. Ventilator- associated pneumonia in paediatric intensive care unit patients: risk factors and outcome. Paediatr. 2002;109:758-64.
14. Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator- associated pneumonia in children. Pediatrics. 2009;123(4):1108-15.
15. Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, El-Ebiary M, Carrillo A, Ruiz J, et al. Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med. 1998;157:371-6.
16. Ruiz M, Torres A, Ewig S, Marcos MA, Alcon A, Liedo R, et al. Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med. 2000;162:119-25.
17. Fabregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de La Bellacasa JP, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54:867-73.
18. Waltrick R, Possamai DS, de Aguiar FP, Dadam M, de Souza Filho VJ, Ramos LR, et al. Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia. Rev Bras Ter Intensiva. 2015;27:260–5.
19. Skrupky LP, McConnell K, Dallas J, Kollef MH. A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria. Crit Care Med. 2012;40:281-4.
20. Wallace FA, Alexander PD, Spencer C, Naisbitt J, Moore JA, McGrath BA. A comparison of ventilator-associated pneumonia rates determined by different scoring systems in four intensive care units in the North West of England. Anaesthesia. 2015;70:1274-80.
21. Younan D, Griffin R, Swain T, Pittet JF, Camins B. Trauma patients meeting both Centers for Disease Control and Prevention’s definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one. J Surg Res. 2017;216:123-8.
22. Safdar N, O’Horo JC, Mak R, Medow J. Agreement between the Clinical Pulmonary Infection Score and NHSN criteria for surveillance of ventilator associated pneumonia. Int J Infect Control. 2013;9:1-5.
23. Gadappa SM, Behera MK. Ventilator associated pneumonia: incidence, profile and outcome in pediatric intensive care unit of tertiary care centre. Int J Contemp Pediatr. 2018;5:2098-102.
24. Mahantesh S, Bhavana J, Basavaraj GV, Yohonnan SE. Ventilator-associated pneumonia in paediatric intensive care unit at the Indira Gandhi Institute of Child Health. Indian J Immunol Respir Med. 2017;2:36-41.
25. Patra PK, Jayashree M, Singhi S, Ray, Saxena AK. Nosocomial pneumonia in a pediatric intensive care unit. Indian Pediatr. 2007;44:511-8.
26. Sharma M, Jais M, Ranjan R, Kumar V, Singh M, Marwah A. Prospective observational study of ventilator associated pneumonia in pediatric intensive care unit in a tertiary care hospital, New Delhi. Ann Int Med Den Res. 2017;3:6-9.