title: How the modified Clinical Pulmonary Infection Score can identify treatment failure and avoid overusing antibiotics in ventilator-associated pneumonia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil.
authors.forename: Paulo Sérgio Lucas
authors.initials: PS
authors.lastname: da Silva
authors.forename: Vânia Euzébio
authors.initials: VE
authors.lastname: de Aguiar
authors.forename: Marcelo Cunio Machado
authors.initials: MC
authors.lastname: Fonseca
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents
keywords: Children; Clinical Pulmonary Infection Score; Mechanical ventilation; Paediatric intensive care unit; Ventilator-associated pneumonia