Diagnostics and epidemiology in ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) represents a common nosocomial complication arising in the intensive care unit. Owing to concerns regarding the excess morbidity related to VAP, multiple interventions for preventing this syndrome exist. Despite controversy regarding the optimal diagnostic approach to VAP, clinicians now face many external pressures to try to reduce, if not eliminate, VAP. In fact, some organizations consider VAP an entirely preventable event. However, any dialog regarding the outcomes and burden of VAP must rest on an understanding and appreciation of both the diagnostic complexities surrounding VAP and the epidemiology of this condition. In addition, the issues of diagnostics and epidemiology are closely linked. The means employed for diagnosing VAP certainly affect the observed prevalence of VAP. Despite these concerns, several general themes emerge in the literature describing VAP epidemiology. First, VAP rates vary based on the diagnostic approach employed. Second, select cohorts of patients are at high risk for VAP, and patient case-mix clearly influences the epidemiology of VAP. Third, rates of VAP appear higher outside the US, irrespective of the diagnostic paradigm utilized.