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How the modified C linical P ulmonary I nfection S core can identify treatment failure and avoid overusing antibiotics in ventilator‐associated pneumonia
Author(s) -
Silva Paulo Sérgio Lucas,
Aguiar Vânia Euzébio,
Fonseca Marcelo Cunio Machado
Publication year - 2014
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.12710
Subject(s) - medicine , ventilator associated pneumonia , pneumonia , receiver operating characteristic , antibiotics , intensive care medicine , area under the curve , microbiology and biotechnology , biology
Abstract Aim Although the modified Clinical Pulmonary Infection Score ( CPIS ) has been used to guide treatment decisions in adults with ventilator‐associated pneumonia ( VAP ), paediatric studies are lacking. We assessed a modified CPIS tool to define VAP resolution and identify treatment failure at an early stage. Methods We identified 70 mechanically ventilated children with VAP according to the Center for Disease Control criteria. Modified CPIS was initially measured at VAP onset and then three and five days afterwards. Children were defined as low risk or high risk based on a cut‐off score of six. Results There were 50 high‐risk and 20 low‐risk patients. Culture results were positive in 64% of the high‐risk patients and just 10% of the low‐risk patients. Patients on adequate therapy significantly improved their CPIS scores by day three, regardless of the likelihood of VAP . A lack of score improvement demonstrated sensitivity of 100% and specificity of 83% when it came to detecting treatment failure. The area under the receiver operating curve was 0.92. Conclusion Serial modified CPIS measurements showed that low‐risk patients with negative cultures at day three should be considered for a short course of antibiotics. In contrast, high‐risk patients with no score improvement were potentially failing their treatment.