Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices

Affiliations

¹ Department of Medicine, Department of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca st. Second floor pulmonary, Baltimore, MD, 21201, USA. Blaine.kenaa@som.umaryland.edu.
² Division of Internal Medicine, PGY-3, Department of Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA.
³ Infectious Diseases, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street, Baltimore, MD, 21201, USA.
⁴ Health Sciences and Human Services Library, University of Maryland Baltimore, 601 W. Lombard St., Baltimore, MD, 21201, USA.
⁵ Pathology and Laboratory Medicine, Medicine Education and Research Building, Lewis Katz School of Medicine, 3500 N. Broad St., Philadelphia, PA, 19140, USA.
⁶ Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA.
⁷ Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD, 21201, USA.
⁸ Department of Medicine, Department of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca st. Second floor pulmonary, Baltimore, MD, 21201, USA.

PMID: 31754887
DOI: 10.1007/s11908-019-0708-3

Review

Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices

Blaine Kenaa et al. Curr Infect Dis Rep. 2019.

. 2019 Nov 21;21(12):50.

doi: 10.1007/s11908-019-0708-3.

Authors

Affiliations

¹ Department of Medicine, Department of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca st. Second floor pulmonary, Baltimore, MD, 21201, USA. Blaine.kenaa@som.umaryland.edu.
² Division of Internal Medicine, PGY-3, Department of Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA.
³ Infectious Diseases, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street, Baltimore, MD, 21201, USA.
⁴ Health Sciences and Human Services Library, University of Maryland Baltimore, 601 W. Lombard St., Baltimore, MD, 21201, USA.
⁵ Pathology and Laboratory Medicine, Medicine Education and Research Building, Lewis Katz School of Medicine, 3500 N. Broad St., Philadelphia, PA, 19140, USA.
⁶ Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, N3W42, 22 S. Greene Street, Baltimore, MD, 21201, USA.
⁷ Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD, 21201, USA.
⁸ Department of Medicine, Department of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca st. Second floor pulmonary, Baltimore, MD, 21201, USA.

PMID: 31754887
DOI: 10.1007/s11908-019-0708-3

Abstract

Purpose of review: Ventilator-associated pneumonia (VAP) is one of the most common infections in the ICU. Prompt diagnosis is vital as mortality increases with delayed antibiotic therapy. However, accurate diagnosis is challenging due to non-specific clinical features in a complicated patient cohort. Microbiological culture data remains a crucial aspect in confirming diagnosis.

Recent findings: Literature data comparing the benefit of invasive respiratory sampling to non-invasive is inconclusive. Differences in culturing practices translate in overidentification of organisms of unclear significance. Positive culture data in a low pre-test probability does not differentiate between true infection and colonization resulting in overtreatment. Furthermore, there are also opportunities for modifying the reporting of respiratory tract cultures that can better guide antimicrobial therapy. Under the umbrella of antimicrobial stewardship, diagnostic stewardship can be incorporated to create a systematic approach that would target culturing practices to match the right pre-test probability. Ideal outcome will be targeting cultures to the right patient population and minimizing unnecessary treatment.

Keywords: Antimicrobial stewardship; Diagnostic stewardship; Endotracheal aspirate; Invasive respiratory culturing; Selective culture reporting; Ventilator-associated pneumonia.

PubMed Disclaimer

References

1. BMJ Open Respir Res. 2014 Dec 16;1(1):e000066 - PubMed
1. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111 - PubMed
1. Infect Control Hosp Epidemiol. 2016 Apr;37(4):448-54 - PubMed
1. Lancet Infect Dis. 2017 Sep;17(9):990-1001 - PubMed
1. Crit Care Med. 2017 Aug;45(8):1268-1275 - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Springer
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices

Affiliations

Ventilator-Associated Pneumonia: Diagnostic Test Stewardship and Relevance of Culturing Practices

Authors

Affiliations

Abstract

References

Publication types

LinkOut - more resources

Full Text Sources

Research Materials