Diagnosis, management and prevention of ventilator-associated pneumonia in the UK.
OBJECTIVE
Ventilator-associated pneumonia is a nosocomial infection that occurs in patients receiving mechanical ventilation for >48 h. Many aspects of its diagnosis, treatment and management are controversial. We used a postal questionnaire to survey current practice within the UK.


METHODS
Questionnaire study of 207 general intensive care units in the UK.


RESULTS
The response rate was 77.3%. Regarding diagnosis, 30% of units obtained specimens from the lungs invasively, while the remainder relied on tracheal aspirates. In only 28.2% of units using tracheal aspirates were results reported in a quantitative manner. A clinical suspicion of ventilator-associated pneumonia would lead to the administration of empirical antibiotic therapy in the majority of units (77.2%), opinion being almost equally divided on whether this should be mono (49.1%) or combination therapy (50.9%). Although most units received regular microbiology feedback (90.5%), the involvement of a microbiologist in the antibiotic decision-making process was variable. Antibiotics were continued for a median of 7 days (inter-quartile range 5-8.5, range 2-14 days). Compliance with the principal methods of ventilator-associated pneumonia prevention was good.


CONCLUSIONS
There is widespread variation in the methods used for the diagnosis of ventilator-associated pneumonia within the UK. The majority of units rely on non-quantitative analysis of tracheal aspirates. This technique has a high percentage of false-positives, and suggests widespread over utilization of antibiotics. However, most agree that antibiotics should be given empirically when there is a clinical suspicion of ventilator-associated pneumonia. The widespread introduction of 'ventilator bundles' appears to have ensured that most units actively take measures to prevent ventilator-associated pneumonia.
Hunter
J
J
Macclesfield District General Hospital, Department of Anaesthetics and Intensive Care, Macclesfield, UK. john.hunter@echeshire-tr.nwest.nhs.uk
Annadurai
S
S
Rothwell
M
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003422:Critical Care / Q000706:statistics & numerical data; D004363:Drug Utilization; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D011795:Surveys and Questionnaires; D014132:Trachea / Q000382:microbiology; D006113:United Kingdom
D000900:Anti-Bacterial Agents