title: Ventilator-associated pneumonia: overdiagnosis and treatment are common in medical and surgical intensive care units.
abstract: OBJECTIVE
  Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days.
  
  
  METHODS
  Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team's VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3.
  
  
  RESULTS
  Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP by the committee. Antibiotics were continued for 120 (76%) of 158 events without VAP on day 3. After adjusting for acute physiology and chronic health evaluation II score and requiring vasopressors on day 1, sputum culture collection on day 3 was significantly associated with antibiotic continuation in patients without VAP. Patients without VAP or other infection received 1,183 excess days of antibiotics during the study.
  
  
  CONCLUSIONS
  Overdiagnosis and treatment of VAP was common in this study and led to 1,183 excess days of antibiotics in patients with no indication for antibiotics. Clinical differences between non-VAP patients who had antibiotics continued or discontinued were minimal, suggesting that clinician preferences and behaviors contribute to unnecessary prescribing.
authors: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Veronique
authors: V
authors: Nussenblatt
authors: Edina
authors: E
authors: Avdic
authors: Sean
authors: S
authors: Berenholtz
authors: Elizabeth
authors: E
authors: Daugherty
authors: Eric
authors: E
authors: Hadhazy
authors: Pamela A
authors: PA
authors: Lipsett
authors: Lisa L
authors: LL
authors: Maragakis
authors: Trish M
authors: TM
authors: Perl
authors: Kathleen
authors: K
authors: Speck
authors: Sandra M
authors: SM
authors: Swoboda
authors: Wendy
authors: W
authors: Ziai
authors: Sara E
authors: SE
authors: Cosgrove
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents