title: Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability.
abstract: OBJECTIVE
  Although quantitative microbiological cultures of samples obtained by bronchoscopy are considered the most specific tool for diagnosing ventilator-associated pneumonia, this labor-intensive invasive technique is not widely used. The Clinical Pulmonary Infection Score (CPIS), a diagnostic algorithm that relies on easily available clinical, radiographic, and microbiological criteria, could be an attractive alternative for diagnosing ventilator-associated pneumonia. Initially, the CPIS scoring system was validated upon 40 quantitative cultures of bronchoalveolar lavage fluid from 28 patients, and only few other studies have evaluated this scoring system since then. Therefore, little is known about the accuracy of this score.
  
  
  METHODS
  We compared the scores of a slightly adjusted CPIS with results from quantitative cultures of bronchoalveolar lavage fluid in 99 consecutive patients with suspicion of ventilator-associated pneumonia, using growth of > or =10(4) cfu/ml in bronchoalveolar lavage fluid as a cut-off for diagnosing ventilator-associated pneumonia. In addition, the CPIS were calculated for 52 patients by two different intensivists to determine the inter-observer variability.
  
  
  RESULTS
  Ventilator-associated pneumonia was diagnosed in 69 (69.6%) patients. When using a CPIS >5 as diagnostic cutoff, the sensitivity of the score was 83% and its specificity was 17%. The area under the Receiver Operating Characteristic curve was 0.55. The level of agreement for prospectively measured Clinical Pulmonary Infection Score (< or =6 and >6) was poor (kappa =0.16).
  
  
  CONCLUSIONS
  When compared to quantitative cultures of bronchoalveolar lavage fluid, the CPIS has a low sensitivity and specificity for diagnosing ventilator-associated pneumonia with considerable inter-observer variability.
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands. K.Schurink@azu.nl.
authors.forename: Carolina A M
authors.initials: CAM
authors.lastname: Schurink
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Christianne A Van
authors.initials: CAV
authors.lastname: Nieuwenhoven
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Maja
authors.initials: M
authors.lastname: Rozenberg-Arska
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Hans C A
authors.initials: HCA
authors.lastname: Joore
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Andy I M
authors.initials: AIM
authors.lastname: Hoepelman
authors.affiliation: Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology , Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical Microbiology, PO Box 85500, HP F02.1263508 GA , Utrecht, The Netherlands.
authors.forename: Marc J M
authors.initials: MJM
authors.lastname: Bonten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D020680:Bronchoscopes; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D012122:Ventilators, Mechanical / Q000009:adverse effects*