Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;158(6):2370-2380.
doi: 10.1016/j.chest.2020.06.034. Epub 2020 Jun 29.

PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU

Stephen P Bergin  1 , Adrian Coles  2 , Sara B Calvert  3 , John Farley  4 , John H Powers  5 , Marcus J Zervos  6 , Matthew Sims  7 , Marin H Kollef  8 , Michael J Durkin  8 , Badih A Kabchi  9 , Helen K Donnelly  10 , Ana Cecilia Bardossy  6 , Claire Greenshields  7 , Daniel Rubin  4 , Jie-Lena Sun  2 , Karen Chiswell  2 , Jonas Santiago  4 , Peidi Gu  2 , Pamela Tenaerts  3 , Vance G Fowler Jr  11 , Thomas L Holland  12
Affiliations

PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU

Stephen P Bergin et al. Chest. 2020 Dec.

Abstract

Background: Pneumonia is the leading infection-related cause of death. The use of simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials.

Research question: What are the clinical criteria and contemporary epidemiology trends that are helpful in the identification of patients at high risk of nosocomial pneumonia?

Study design and methods: Within the ICUs of 28 US hospitals, we conducted a prospective cohort study among adults who had been hospitalized >48 hours and were considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen). We estimated the proportion of high-risk patients who experienced the development of nosocomial pneumonia. Using multivariable logistic regression, we identified patient characteristics and treatment exposures that are associated with increased risk of pneumonia development during the ICU admission.

Results: Between February 6, 2016, and October 7, 2016, 4,613 high-risk patients were enrolled. Among 1,464 high-risk patients (32%) who were treated for possible nosocomial pneumonia, 537 (37%) met the study pneumonia definition. Among high-risk patients, a multivariable logistic model was developed to identify key patient characteristics and treatment exposures that are associated with increased risk of nosocomial pneumonia development (c-statistic, 0.709; 95% CI, 0.686-0.731). Key factors associated with increased odds of nosocomial pneumonia included an admission diagnosis of trauma or cerebrovascular accident, receipt of enteral nutrition, documented aspiration risk, and receipt of systemic antibacterials within the preceding 90 days.

Interpretation: Treatment for nosocomial pneumonia is common among patients in the ICU who are receiving high levels of respiratory support, yet more than one-half of patients who are treated do not fulfill standard diagnostic criteria for pneumonia. Application of simple clinical criteria may improve the feasibility of clinical trials of pneumonia prevention and treatment by facilitating prospective identification of patients at highest risk.

Keywords: ICU; nosocomial; pneumonia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Screening, eligibility, and enrollment of patients who are at risk for nosocomial pneumonia. HABP = hospital-acquired bacterial pneumonia; VABP = ventilator-associated bacterial pneumonia.
Figure 2
Figure 2
Study outcome for high-risk patients. Of 4,613 enrolled high-risk patients, 1,464 (32%) were treated for possible pneumonia during their ICU course; of these, 537 patients (37%) met the study HABP/VABP definition over a median follow-up time of 7 days. See Figure 1 legend for expansion of abbreviations.
Figure 3
Figure 3
Cumulative incidence of nosocomial pneumonia for high-risk patients. See Figure 1 legend for expansion of abbreviations.
See this image and copyright information in PMC

Comment in

References

    1. Magill S.S., O’Leary E., Janelle S.J. Changes in prevalence of health care-associated infections in U.S. hospitals. N Engl J Med. 2018;379(18):1732–1744. - PMC - PubMed
    1. Vincent J.L., Bihari D.J., Suter P.M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274(8):639–644. - PubMed
    1. Kalil A.C., Metersky M.L., Klompas M. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61–e111. - PMC - PubMed
    1. Melsen W.G., Rovers M.M., Groenwold R.H. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–671. - PubMed
    1. Klompas M. Does this patient have ventilator-associated pneumonia? JAMA. 2007;297(14):1583–1593. - PubMed

Publication types

MeSH terms