A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Antoine Gaillet^#^{1

2}, Charles-Edouard Luyt^#^{3

4}, Jean-Francois Timsit⁵, Karim Asehnoune⁶, Francois Barbier⁷, Matteo Bassetti⁸, Lila Bouadma⁵, Adrien Bouglé⁹, Jean Chastre^{3

4}, Andrew Conway Morris¹⁰, Jan J De Waele^{11

12}, François Dépret¹³, George Dimopoulos¹⁴, Stephan Ehrmann¹⁵, Santiago Ewig¹⁶, Muriel Fartoukh¹⁷, Arnaud Foucrier¹⁸, José Garnacho-Montero¹⁹, Sami Hraiech^{20

21}, Marc Leone²², Demosthenes Makris²³, Ignacio Martin-Loeches^{24

25}, Dimitrios Matthaiou²⁶, Antoine Monsel²⁷, Philippe Montravers²⁸, Saad Nseir²⁹, José-Artur Paiva³⁰, Laurent Papazian^{31

32}, Garyfallia Poulakou³³, Pedro Póvoa^{34

35

36}, Jérôme Pugin³⁷, Alejandro H Rodriguez³⁸, Antoine Roquilly⁶, Damien Roux³⁹, Anahita Rouzé²⁹, Fabio Silvio Taccone⁴⁰, Antoni Torres²⁵, Jean-Ralph Zahar⁴¹, Emmanuel Weiss^#¹⁸, Keyvan Razazi^#^{42

43}

Affiliations

¹ Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France. gaillet.antoine75@gmail.com.
² Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France. gaillet.antoine75@gmail.com.
³ Service de Médecine Intensive Réanimation, Institut de Cardiologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ INSERM Umrs_1166-Ican, Institute of Cardiometabolism and Nutrition, Paris, France.
⁵ Université Paris-Cité, IAME, INSERM, Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, AP-HP, Paris, France.
⁶ Service d'Anesthésie Réanimation Chirurgicale Hôtel Dieu, Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Nantes, France.
⁷ Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
⁸ Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS, Genoa, Italy.
⁹ Département d'Anesthésie Et Réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Paris, France.
¹⁰ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
¹¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
¹³ Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis Hospital, Paris Cité University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
¹⁴ Third Department of Critical Care, EVGENIDIO Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
¹⁵ Service de Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSEP F-CRIN Research Network, Centre Hospitalier Régional Universitaire de Tours and INSERM U1100, Centre d'Etude Des Pathologies Respiratoires (CEPR), Université de Tours, Tours, France.
¹⁶ Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Herne and Bochum, Germany.
¹⁷ Médecine Intensive Réanimation, Assistance Publique Hopitaux de Paris, Sorbonne Université, Hôpital Tenon, Paris, Île-de-France, France.
¹⁸ Department of Anesthesiology and Critical Care, Hôpital Beaujon, APHP and Université de Paris Cité, Paris, France.
¹⁹ Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain.
²⁰ Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, Marseille, France.
²¹ Faculté de Médecine, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie, Aix-Marseille Université, EA 3279, Marseille, France.
²² Service d'Anesthésie Et de Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix Marseille Université, CIC 1409 and CIC 9502, Marseille, France.
²³ Critical Care Department, University Hospital of Larissa, Larissa, Greece.
²⁴ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Leinster, Dublin, D08NYH1, Ireland.
²⁵ Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, ICREA Ciberes, Barcelona, Spain.
²⁶ Department of Critical Care, "Ygeias Melathron" Clinic, Athens, Greece.
²⁷ Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France.
²⁸ Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital (AP-HP), University Paris-Cité, INSERM UMR 1152 PHERE, Paris, France.
²⁹ Univ. Lille, Inserm U1285, CHU Lille, Service de Médecine Intensive-Réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale Et Fonctionnelle, Lille, France.
³⁰ Intensive Care Medicine Service, Unidade Local de Saúde de São João, Porto, Portugal.
³¹ Médecine Intensive Réanimation, Centre Hospitalier de Bastia, Bastia, Corsica, France.
³² Università Di Corsica and Aix-Marseille Université, Marseille, France.
³³ Third Department of Internal Medicine and Laboratory, "SOTIRIA" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
³⁴ Department of Intensive Care, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
³⁵ NOVA Medical School, New University of Lisbon, Lisbon, Portugal.
³⁶ Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
³⁷ Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
³⁸ Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain.
³⁹ Service de Médecine Intensive Réanimation, INSERM, CNRS, Institut Necker Enfants Malades, Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Paris, France.
⁴⁰ Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁴¹ Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France.
⁴² Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.
⁴³ Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.

^# Contributed equally.

PMID: 40163131
DOI: 10.1007/s00134-025-07856-7

A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Antoine Gaillet et al. Intensive Care Med. 2025 Mar.

. 2025 Mar;51(3):506-517.

doi: 10.1007/s00134-025-07856-7. Epub 2025 Mar 31.

Authors

Affiliations

¹ Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France. gaillet.antoine75@gmail.com.
² Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France. gaillet.antoine75@gmail.com.
³ Service de Médecine Intensive Réanimation, Institut de Cardiologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ INSERM Umrs_1166-Ican, Institute of Cardiometabolism and Nutrition, Paris, France.
⁵ Université Paris-Cité, IAME, INSERM, Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, AP-HP, Paris, France.
⁶ Service d'Anesthésie Réanimation Chirurgicale Hôtel Dieu, Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Nantes, France.
⁷ Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France.
⁸ Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS, Genoa, Italy.
⁹ Département d'Anesthésie Et Réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Paris, France.
¹⁰ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
¹¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
¹² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
¹³ Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis Hospital, Paris Cité University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
¹⁴ Third Department of Critical Care, EVGENIDIO Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
¹⁵ Service de Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSEP F-CRIN Research Network, Centre Hospitalier Régional Universitaire de Tours and INSERM U1100, Centre d'Etude Des Pathologies Respiratoires (CEPR), Université de Tours, Tours, France.
¹⁶ Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Herne and Bochum, Germany.
¹⁷ Médecine Intensive Réanimation, Assistance Publique Hopitaux de Paris, Sorbonne Université, Hôpital Tenon, Paris, Île-de-France, France.
¹⁸ Department of Anesthesiology and Critical Care, Hôpital Beaujon, APHP and Université de Paris Cité, Paris, France.
¹⁹ Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Seville, Spain.
²⁰ Service de Médecine Intensive-Réanimation, AP-HM, Hôpital Nord, Marseille, France.
²¹ Faculté de Médecine, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie, Aix-Marseille Université, EA 3279, Marseille, France.
²² Service d'Anesthésie Et de Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix Marseille Université, CIC 1409 and CIC 9502, Marseille, France.
²³ Critical Care Department, University Hospital of Larissa, Larissa, Greece.
²⁴ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Leinster, Dublin, D08NYH1, Ireland.
²⁵ Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, ICREA Ciberes, Barcelona, Spain.
²⁶ Department of Critical Care, "Ygeias Melathron" Clinic, Athens, Greece.
²⁷ Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France.
²⁸ Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital (AP-HP), University Paris-Cité, INSERM UMR 1152 PHERE, Paris, France.
²⁹ Univ. Lille, Inserm U1285, CHU Lille, Service de Médecine Intensive-Réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale Et Fonctionnelle, Lille, France.
³⁰ Intensive Care Medicine Service, Unidade Local de Saúde de São João, Porto, Portugal.
³¹ Médecine Intensive Réanimation, Centre Hospitalier de Bastia, Bastia, Corsica, France.
³² Università Di Corsica and Aix-Marseille Université, Marseille, France.
³³ Third Department of Internal Medicine and Laboratory, "SOTIRIA" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
³⁴ Department of Intensive Care, São Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
³⁵ NOVA Medical School, New University of Lisbon, Lisbon, Portugal.
³⁶ Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
³⁷ Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
³⁸ Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain.
³⁹ Service de Médecine Intensive Réanimation, INSERM, CNRS, Institut Necker Enfants Malades, Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Paris, France.
⁴⁰ Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁴¹ Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France.
⁴² Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.
⁴³ Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.

^# Contributed equally.

PMID: 40163131
DOI: 10.1007/s00134-025-07856-7

Abstract

Background: There are recognized diagnostic criteria for a first ventilator-associated pneumonia (VAP) episode, but not for recurrences. Many randomized clinical trials (RCTs) have used the recurrence of VAP as a criterion for efficacy evaluation. Still, the different definitions used in RCTs make it difficult to compare studies. We aimed to develop a consensual definition of VAP recurrences and of the various types of VAP recurrences.

Methods: Thirty-six European experts constituting a multidisciplinary group of physicians (critical care, infectious diseases, microbiology) with special interest in the management of VAP were polled using the Delphi methodology.

Results: After the completion of four iterations of the DELPHI method, 94% of experts agreed that the diagnostic criteria for a first VAP episode could also be used for recurrences, except for the radiological criterion, which not all the experts considered to be mandatory. Consensus was also reached regarding the definition of four distinct entities: relapse, persistent VAP, superinfection, and new-pathogen VAP. For relapse and persistent VAP, bacteriological findings were identical for different VAP episodes, whereas they differed for superinfection and new-pathogen VAP. The distinction between relapse and persistent VAP, and between superinfection and new-pathogen VAP depended on the timing of antibiotic treatment (before or after 48-72 h after the end of antibiotic therapy) and the clinical course. Microbiological criteria were proposed to facilitate the diagnosis of persistent VAP.

Conclusion: This consensus by European experts proposes four different VAP recurrence entities which should facilitate the harmonization of recurrence criteria for clinical practice and future studies.

Keywords: Delphi; European; Persistent VAP; Recurrence; Relapse; Superinfection; Ventilator-associated pneumonia (VAP).

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Conflict of interest statement

Declarations. Conflicts of interest: C-E. L. received lecture fees from AdvanzPharma, Merck and Aerogen, grants from Merck and AdvanzPharma, and travel grants from Pfizer, all outside the submitted work. E. W. received a research grant and lecture fees from LFB, all outside the submitted work. K. R. received lecture fees from Shionogi, MSD, and a travel grant from Pfizer, all outside the submitted work. P. P. received lecture fess from Gilead, Pfizer, Mundipharma, MSD and advisory board from Biocodex, Gilead. J. J. D. W. has consulted for Roche Diagnostics, Menarini, MSD, Pfizer, ThermoFisher and Viatris (fees and honoraria paid to institution). A. C. M. is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1). I. M. L. received grant from Grifols to my institution, consulting fees from MSD and Gilead, lectures fees from Gilead, Pfizer, Mundipharma and MSD. P. M. received consulting and lectures fees from Pfizer, Menarini, Viatris and Mundipharma, and participate to the Data Safety Monitoring Board or Advisory Board of Mundipharma and Viatris. F. B. received support from Shionogi and Pfizer, and grants from MSD. L. P. received grants from GIRCI, payment for expert testimony from Air Liquid Medical Systems, support for attending meetings from SMAAR and SRLF, participation on a Data Safety Monitoring Board or Advisory Board of BetaHypershock. K. A. received consulting fees from Edwards Life Science, honoraria for lectures from LFB, Baxter and Edwards Life Science. S. N. received consulting fees from MundiPharma, honoraria for lectures from MSD, Pfizer, Biomérieux, Fisher and Peykel, Medtronic. A. R. received European grants from Commission Horizon Europe—2024–2028, consulting fees from MSD. A. R. received payment or honoraria for lectures from Gilead, Pfizer and Mundipharma. G. P. received consulting fees from Pfizer, MSD, Menarini, GSK and GILEAD. G. D. received consulting fees from Pfizer, Viatris, Menarini, Gilead, ELPEN and InfectoPharm. S. H. received support for attending meetings from Pfizer and MSD. A. R. received payment or honoraria for lectures from MSD, Gilead and Mundipharma. S. E. received grants from Aerogen Ltd, Fisher & Paykel Healthcare and Open AI. F. D. received payment or honoraria for lectures from Biomerieux lecture and Septicyte lecture fee. D. R received grants from two institutional grants for clinical research from French ministry of health (COTRVAP and LOSTINDIAB). M. L. received consulting fees from Viatris and AOP, payment or honoraria for lectures Shionogi. S. H. received support for attending meetings from MSD and Pfizer. J-R. Z. received payment or honoraria for lectures from MSD, Shionogi, Gilead and Pfizer. J-A. P. participated to lectures and Advisory Boards for Pfizer, Merck-Sharp-Dohme, Gilead, Cepheid, AOP Orphan Pharmaceuticals. J. C. participate on a Data Safety Monitoring Board or Advisory Board Inotrem, Kenta/Aridis, PharmaMar and Aptarion DSMB. M. F. received payment or honoraria for lectures from Fisher & Paykel, BioMérieux and SOS oxygène. M. B. reports research grants and/or advisor/consultant and/or speaker/chairman for Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfzer, Shionogi and Thermo-Fisher, outside the submitted work.

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A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Affiliations

A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources