Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

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Abstract

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability. © Annals of Translational Medicine.
Original languageEnglish
JournalAnnals of Translational Medicine
Volume5
Issue number22
DOIs
Publication statusPublished - Nov 2017

Fingerprint

Ventilator-Associated Pneumonia
Anti-Bacterial Agents
Delivery of Health Care
Intensive Care Units
Safety
Mechanical Ventilators
Centers for Disease Control and Prevention (U.S.)
Incidence
Epidemiologic Factors
Benchmarking
Translational Medical Research
Quality of Health Care

Keywords

  • Antibiotic
  • Intensive care unit (ICU)
  • Ventilator-associated pneumonia (VAP)

Cite this

@article{bc40926779ca4effa1a7abe36c20e084,
title = "Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies",
abstract = "Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15{\%} of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability. {\circledC} Annals of Translational Medicine.",
keywords = "Antibiotic, Intensive care unit (ICU), Ventilator-associated pneumonia (VAP)",
author = "D. Nora and P. P{\'o}voa",
note = "Export Date: 11 December 2017 Correspondence Address: Nora, D.; Unidade de Cuidados Intensivos Polivalente-Piso 1, Hospital de S{\~a}o Francisco Xavier, Estrada do Forte do Alto do DuquePortugal; email: davidjgarcianora@gmail.com References: Fihman, V., Messika, J., Hajage, D., Five-year trends for ventilator-associated pneumonia: Correlation between microbiological findings and antimicrobial drug consumption (2015) Int J Antimicrob Agents, 46, pp. 518-525; Ferreira, C.R., De Souza, D.F., Cunha, T.M., The effectiveness of a bundle in the prevention of ventilator-associated pneumonia (2016) Braz J Infect Dis, 20, pp. 267-271; Skrupky, L.P., McConnell, K., Dallas, J., A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria (2012) Crit Care Med, 40, pp. 281-284; Gupta, R., Malik, A., Rizvi, M., Epidemiology of multidrug-resistant Gram-negative pathogens isolated from ventilator-associated pneumonia in ICU patients (2017) J Glob Antimicrob Resist, 9, pp. 47-50; Martin-Loeches, I., Povoa, P., Rodriguez, A., Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study (2015) Lancet Respir Med, 3, pp. 859-868; Ventilator-Associated Event (VAE) Protocol [Internet] 2017, , https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf; Craven, D.E., Lei, Y., Ruthazer, R., Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia (2013) Am J Med, 126, pp. 542-549; Craven, D.E., Hudcova, J., Lei, Y., Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: {"}thinking outside the box.{"} (2016) Crit Care, 20, p. 300; Craven, D.E., Preventing Ventilator-Associated Pneumonia in Adults-Sowing Seeds of Change (2006) Chest, 130, pp. 251-260; Younan, D., Griffin, R., Swain, T., Trauma patients meeting both Centers for Disease Control and Prevention's definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one (2017) J Surg Res, 216, pp. 123-128; Klompas, M., Berra, L., Should Ventilator-Associated Events become a Quality Indicator for ICUs? (2016) Respir Care, 61, pp. 723-736; Kobayashi, H., Uchino, S., Takinami, M., The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation Respir Care 2017, , [Epub ahead of print]; Klompas, M., Interobserver variability in ventilator-associated pneumonia surveillance (2010) Am J Infect Control, 38, pp. 237-239; Tejerina, E., Esteban, A., Fern{\'a}ndez-Segoviano, P., Accuracy of Clinical Definitions of Ventilator-Associated Pneumonia: Comparison With Autopsy Findings (2010) J Crit Care, 25, pp. 62-68; Kalanuria, A.A., Zai, W., Mirski, M., Ventilator-associated pneumonia in the ICU (2014) Crit Care, 18, p. 208; Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event [Internet] 2015, , http://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf; Klompas, M., Complications of Mechanical Ventilation-The CDC's New Surveillance Paradigm (2013) N Engl J Med, 368, pp. 1472-1475; Mietto, C., Pinciroli, R., Pharmd, N.P., Ventilator Associated Pneumonia: Evolving Definitions and Preventive Strategies (2013) Respir Care, 58, pp. 990-1007; Morris, A.C., Kefala, K., Simpson, A.J., Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia (2009) Thorax, 64, pp. 516-522; Klompas, M., Khan, Y., Kleinman, K., Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation (2011) PLoS One, 6, pp. 1-7; Bor, C., Demirag, K., Okcu, O., Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage (2015) Pak J Med Sci, 31, pp. 1441-1446; Rosenthal, V.D., Al-Abdely, H.M., El-Kholy, A.A., International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associatedmodule (2016) Am J Infect Control, 44, pp. 1495-1504; Rodr{\'i}guez, A., P{\'o}voa, P., Nseir, S., Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey (2014) Crit Care, 18, p. R32; Dudeck, M.A., Weiner, L.M., Allen-Bridson, K., National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module (2013) Am J Infect Control, 41, pp. 1148-1166; https://shea.confex.com/data/abstract/shea/2010/Paper_1745_abstract_734_0.gif{\%}0D{\%}0A, [cited 2017 Jun 22]; Dudeck, M.A., Horan, T.C., Peterson, K.D., National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module (2011) Am J Infect Control, 39, pp. 798-816; Dudeck, M.A., Horan, T.C., Peterson, K.D., National Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-associated Module (2013) Am J Infect Control, 41, pp. 286-300; Annual Epidemiological Report 2016-Healthcare-associated infections acquired in intensive care units, , https://ecdc.europa.eu/en/publications-data/health, Stockholm: ECDC; 2016; (2013) Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, , Stockholm: ECDC; (2007), ecdc.europa.eu/en/publications/Publications/120215_SUR_HAI_2007.pdf, Stockholm: ECDC; 2012; Klompas, M., Eight initiatives that misleadingly lower ventilator-associated pneumonia rates (2012) Am J Infect Control, 40, pp. 408-410; Lisboa, T., Rello, J., Towards zero rate in healthcare-associated infections: one size shall not fit all (2013) Crit Care, 17, p. 139; Chin, T., Kushner, B., DerschMills, D., Antibiotic Utilization Patterns in Patients with Ventilator-Associated Pneumonia: A Canadian Context (2016) Can J Infect Dis Med Microbiol, 2016; Arthur, L.E., Kizor, R.S., Selim, A.G., Antibiotics for ventilator-associated pneumonia (2016) Cochrane Database Syst Rev, 10; Kalil, A.C., Metersky, M.L., Klompas, M., Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society (2016) Clin Infect Dis, 63, pp. e61-e111; Zilahi, G., McMahon, M.A., Povoa, P., Duration of antibiotic therapy in the intensive care unit (2016) J Thorac Dis, 8, pp. 3774-3780; Rosenthal, V.D., Rodrigues, C., {\'A}lvarez-Moreno, C., Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: Findings of the International Nosocomial Infection Control Consortium (2012) Crit Care Med, 40, pp. 3121-3128; Su, S.Y., Chao, C., Lai, C.C., The Association Between Antibiotic Consumption and the Rate of Ventilator-Associated Pneumonia in the ICU (2013) Crit Care Med, 41, pp. e53-e54; Hanberger, H., Arman, D., Gill, H., Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control (2009) Intensive Care Med, 35, pp. 91-100; (2016) Summary of the latest data on antibiotic consumption in the European Union. European Surveillance of Antimicrobial Consumption Network surveillance data, , http://ecdc.europa.eu/en/eaad/Documents/EARS-Net-summary-antibiotic-resistance.pdf, Stockohlm: ECDC; Magill, S.S., Edwards, J.R., Beldavs, Z.G., Prevalence of Antimicrobial Use in US Acute Care Hospitals, May-September 2011 (2014) JAMA, 312, pp. 1438-1446; Baggs, J., Fridkin, S.K., Pollack, L.A., Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012 (2016) JAMA Intern Med, 176, pp. 1639-1648; Chastre, J., Fagon, J., State of the Art: Ventilator-associated Pneumonia Jean (2002) Am J Respir Crit Care Med, 165, pp. 867-903; Koulenti, D., Lisboa, T., Brun-Buisson, C., Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units (2009) Crit Care Med, 37, pp. 2360-2368; Berrington, A., Antimicrobial prescribing in hospitals: be careful what you measure (2010) J Antimicrob Chemother, 65, pp. 163-168; Weiner, L.M., Webb, A.K., Limbago, B., Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011-2014 (2016) Infect Control Hosp Epidemiol, 37, pp. 1288-1301; (2015) Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections, , Stockholm: ECDC; Lachiewicz, A.M., Weber, D.J., van Duin, D., From VAP to VAE: Implications of the New CDC Definitions on a Burn Intensive Care Unit Population (2017) Infect Control Hosp Epidemiol, 38, pp. 867-869",
year = "2017",
month = "11",
doi = "10.21037/atm.2017.09.16",
language = "English",
volume = "5",
journal = "Annals of Translational Medicine",
issn = "2305-5839",
publisher = "AME Publishing Company",
number = "22",

}

TY - JOUR

T1 - Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

AU - Nora, D.

AU - Póvoa, P.

N1 - Export Date: 11 December 2017 Correspondence Address: Nora, D.; Unidade de Cuidados Intensivos Polivalente-Piso 1, Hospital de São Francisco Xavier, Estrada do Forte do Alto do DuquePortugal; email: davidjgarcianora@gmail.com References: Fihman, V., Messika, J., Hajage, D., Five-year trends for ventilator-associated pneumonia: Correlation between microbiological findings and antimicrobial drug consumption (2015) Int J Antimicrob Agents, 46, pp. 518-525; Ferreira, C.R., De Souza, D.F., Cunha, T.M., The effectiveness of a bundle in the prevention of ventilator-associated pneumonia (2016) Braz J Infect Dis, 20, pp. 267-271; Skrupky, L.P., McConnell, K., Dallas, J., A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria (2012) Crit Care Med, 40, pp. 281-284; Gupta, R., Malik, A., Rizvi, M., Epidemiology of multidrug-resistant Gram-negative pathogens isolated from ventilator-associated pneumonia in ICU patients (2017) J Glob Antimicrob Resist, 9, pp. 47-50; Martin-Loeches, I., Povoa, P., Rodriguez, A., Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study (2015) Lancet Respir Med, 3, pp. 859-868; Ventilator-Associated Event (VAE) Protocol [Internet] 2017, , https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf; Craven, D.E., Lei, Y., Ruthazer, R., Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia (2013) Am J Med, 126, pp. 542-549; Craven, D.E., Hudcova, J., Lei, Y., Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: "thinking outside the box." (2016) Crit Care, 20, p. 300; Craven, D.E., Preventing Ventilator-Associated Pneumonia in Adults-Sowing Seeds of Change (2006) Chest, 130, pp. 251-260; Younan, D., Griffin, R., Swain, T., Trauma patients meeting both Centers for Disease Control and Prevention's definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one (2017) J Surg Res, 216, pp. 123-128; Klompas, M., Berra, L., Should Ventilator-Associated Events become a Quality Indicator for ICUs? (2016) Respir Care, 61, pp. 723-736; Kobayashi, H., Uchino, S., Takinami, M., The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation Respir Care 2017, , [Epub ahead of print]; Klompas, M., Interobserver variability in ventilator-associated pneumonia surveillance (2010) Am J Infect Control, 38, pp. 237-239; Tejerina, E., Esteban, A., Fernández-Segoviano, P., Accuracy of Clinical Definitions of Ventilator-Associated Pneumonia: Comparison With Autopsy Findings (2010) J Crit Care, 25, pp. 62-68; Kalanuria, A.A., Zai, W., Mirski, M., Ventilator-associated pneumonia in the ICU (2014) Crit Care, 18, p. 208; Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event [Internet] 2015, , http://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf; Klompas, M., Complications of Mechanical Ventilation-The CDC's New Surveillance Paradigm (2013) N Engl J Med, 368, pp. 1472-1475; Mietto, C., Pinciroli, R., Pharmd, N.P., Ventilator Associated Pneumonia: Evolving Definitions and Preventive Strategies (2013) Respir Care, 58, pp. 990-1007; Morris, A.C., Kefala, K., Simpson, A.J., Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia (2009) Thorax, 64, pp. 516-522; Klompas, M., Khan, Y., Kleinman, K., Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation (2011) PLoS One, 6, pp. 1-7; Bor, C., Demirag, K., Okcu, O., Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage (2015) Pak J Med Sci, 31, pp. 1441-1446; Rosenthal, V.D., Al-Abdely, H.M., El-Kholy, A.A., International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associatedmodule (2016) Am J Infect Control, 44, pp. 1495-1504; Rodríguez, A., Póvoa, P., Nseir, S., Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey (2014) Crit Care, 18, p. R32; Dudeck, M.A., Weiner, L.M., Allen-Bridson, K., National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module (2013) Am J Infect Control, 41, pp. 1148-1166; https://shea.confex.com/data/abstract/shea/2010/Paper_1745_abstract_734_0.gif%0D%0A, [cited 2017 Jun 22]; Dudeck, M.A., Horan, T.C., Peterson, K.D., National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module (2011) Am J Infect Control, 39, pp. 798-816; Dudeck, M.A., Horan, T.C., Peterson, K.D., National Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-associated Module (2013) Am J Infect Control, 41, pp. 286-300; Annual Epidemiological Report 2016-Healthcare-associated infections acquired in intensive care units, , https://ecdc.europa.eu/en/publications-data/health, Stockholm: ECDC; 2016; (2013) Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, , Stockholm: ECDC; (2007), ecdc.europa.eu/en/publications/Publications/120215_SUR_HAI_2007.pdf, Stockholm: ECDC; 2012; Klompas, M., Eight initiatives that misleadingly lower ventilator-associated pneumonia rates (2012) Am J Infect Control, 40, pp. 408-410; Lisboa, T., Rello, J., Towards zero rate in healthcare-associated infections: one size shall not fit all (2013) Crit Care, 17, p. 139; Chin, T., Kushner, B., DerschMills, D., Antibiotic Utilization Patterns in Patients with Ventilator-Associated Pneumonia: A Canadian Context (2016) Can J Infect Dis Med Microbiol, 2016; Arthur, L.E., Kizor, R.S., Selim, A.G., Antibiotics for ventilator-associated pneumonia (2016) Cochrane Database Syst Rev, 10; Kalil, A.C., Metersky, M.L., Klompas, M., Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society (2016) Clin Infect Dis, 63, pp. e61-e111; Zilahi, G., McMahon, M.A., Povoa, P., Duration of antibiotic therapy in the intensive care unit (2016) J Thorac Dis, 8, pp. 3774-3780; Rosenthal, V.D., Rodrigues, C., Álvarez-Moreno, C., Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: Findings of the International Nosocomial Infection Control Consortium (2012) Crit Care Med, 40, pp. 3121-3128; Su, S.Y., Chao, C., Lai, C.C., The Association Between Antibiotic Consumption and the Rate of Ventilator-Associated Pneumonia in the ICU (2013) Crit Care Med, 41, pp. e53-e54; Hanberger, H., Arman, D., Gill, H., Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control (2009) Intensive Care Med, 35, pp. 91-100; (2016) Summary of the latest data on antibiotic consumption in the European Union. European Surveillance of Antimicrobial Consumption Network surveillance data, , http://ecdc.europa.eu/en/eaad/Documents/EARS-Net-summary-antibiotic-resistance.pdf, Stockohlm: ECDC; Magill, S.S., Edwards, J.R., Beldavs, Z.G., Prevalence of Antimicrobial Use in US Acute Care Hospitals, May-September 2011 (2014) JAMA, 312, pp. 1438-1446; Baggs, J., Fridkin, S.K., Pollack, L.A., Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012 (2016) JAMA Intern Med, 176, pp. 1639-1648; Chastre, J., Fagon, J., State of the Art: Ventilator-associated Pneumonia Jean (2002) Am J Respir Crit Care Med, 165, pp. 867-903; Koulenti, D., Lisboa, T., Brun-Buisson, C., Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units (2009) Crit Care Med, 37, pp. 2360-2368; Berrington, A., Antimicrobial prescribing in hospitals: be careful what you measure (2010) J Antimicrob Chemother, 65, pp. 163-168; Weiner, L.M., Webb, A.K., Limbago, B., Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011-2014 (2016) Infect Control Hosp Epidemiol, 37, pp. 1288-1301; (2015) Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections, , Stockholm: ECDC; Lachiewicz, A.M., Weber, D.J., van Duin, D., From VAP to VAE: Implications of the New CDC Definitions on a Burn Intensive Care Unit Population (2017) Infect Control Hosp Epidemiol, 38, pp. 867-869

PY - 2017/11

Y1 - 2017/11

N2 - Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability. © Annals of Translational Medicine.

AB - Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability. © Annals of Translational Medicine.

KW - Antibiotic

KW - Intensive care unit (ICU)

KW - Ventilator-associated pneumonia (VAP)

U2 - 10.21037/atm.2017.09.16

DO - 10.21037/atm.2017.09.16

M3 - Review article

VL - 5

JO - Annals of Translational Medicine

JF - Annals of Translational Medicine

SN - 2305-5839

IS - 22

ER -