title: Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia.
abstract: OBJECTIVE
  >To evaluate the agreement between a new epidemiological surveillance method of the Center for Disease Control and Prevention and the clinical pulmonary infection score for mechanical ventilator-associated pneumonia detection.
  
  
  METHODS
  This was a prospective cohort study that evaluated patients in the intensive care units of two hospitals who were intubated for more than 48 hours between August 2013 and June 2014. Patients were evaluated daily by physical therapist using the clinical pulmonary infection score. A nurse independently applied the new surveillance method proposed by the Center for Disease Control and Prevention. The diagnostic agreement between the methods was evaluated. A clinical pulmonary infection score of ≥ 7 indicated a clinical diagnosis of mechanical ventilator-associated pneumonia, and the association of a clinical pulmonary infection score ≥ 7 with an isolated semiquantitative culture consisting of ≥ 104 colony-forming units indicated a definitive diagnosis.
  
  
  RESULTS
  Of the 801 patients admitted to the intensive care units, 198 required mechanical ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18 (10.7%) cases of mechanical ventilation-associated infectious conditions were identified, 14 (8.3%) of which exhibited possible or probable mechanical ventilator-associated pneumonia, which represented 35% (14/38) of mechanical ventilator-associated pneumonia cases. The Center for Disease Control and Prevention method identified cases of mechanical ventilator-associated pneumonia with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.84. The differences resulted in discrepancies in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000 days of mechanical ventilation; clinical pulmonary infection score ≥ 7, 13.1/1000 days of mechanical ventilation).
  
  
  CONCLUSIONS
  The Center for Disease Control and Prevention method failed to detect mechanical ventilator-associated pneumonia cases and may not be satisfactory as a surveillance method.
authors.affiliation: Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Renata
authors.initials: R
authors.lastname: Waltrick
authors.affiliation: Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Dimitri Sauter
authors.initials: DS
authors.lastname: Possamai
authors.affiliation: Serviço de Fisioterapia, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Fernanda Perito
authors.initials: FP
authors.lastname: de Aguiar
authors.affiliation: Serviço de Fisioterapia, Centro Hospitalar Unimed, Joinville, SC, BR.
authors.forename: Micheli
authors.initials: M
authors.lastname: Dadam
authors.affiliation: Faculdade de Medicina, Universidade da Região de Joinville, Joinville, SC, BR.
authors.forename: Valmir João
authors.initials: VJ
authors.lastname: de Souza Filho
authors.affiliation: Faculdade de Medicina, Universidade da Região de Joinville, Joinville, SC, BR.
authors.forename: Lucas Rocker
authors.initials: LR
authors.lastname: Ramos
authors.affiliation: Comissão de Controle de Infecção Hospitalar, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Renata da Silva
authors.initials: Rda S
authors.lastname: Laurett
authors.affiliation: Comissão de Controle de Infecção Hospitalar, Centro Hospitalar Unimed, Joinville, SC, BR.
authors.forename: Kênia
authors.initials: K
authors.lastname: Fujiwara
authors.affiliation: Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Milton
authors.initials: M
authors.lastname: Caldeira Filho
authors.affiliation: Comissão de Controle de Infecção Hospitalar, Centro Hospitalar Unimed, Joinville, SC, BR.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Koenig
authors.affiliation: Programa de Residência em Medicina Intensiva, Hospital Municipal São José, Joinville, SC, BR.
authors.forename: Glauco Adrieno
authors.initials: GA
authors.lastname: Westphal
mesh_terms: D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States