3
Diagnosis
Microbiologic Methods
Î ATS and IDSA suggest noninvasive sampling with semiquantitative
cultures to diagnose VAP, rather than invasive sampling with
quantitative cultures and rather than noninvasive sampling with
quantitative cultures (W-L).
Î Noninvasive sampling with semiquantitative cultures is the preferred
methodology to diagnose VAP. However, the panel recognizes that
invasive quantitative cultures will occasionally be performed by some
clinicians. For patients with suspected VAP whose invasive quantitative
culture results are below the diagnostic threshold for VAP, ATS and
IDSA suggest that antibiotics be withheld rather than continued (W-VL).
Î ATS and IDSA suggest that patients with suspected HAP (non-VAP) be
treated according to the results of microbiologic studies performed on
respiratory samples obtained noninvasively, rather than being treated
empirically (W-VL).
Biomarkers
Î For patients with suspected HAP/VAP, ATS and IDSA recommend
using clinical criteria alone, rather than using serum procalcitonin plus
clinical criteria, to decide whether or not to initiate antibiotic therapy
(S-M).
Î For patients with suspected HAP/VAP, ATS and IDSA recommend using
clinical criteria alone, rather than using bronchoalveolar fluid sTREM-1
plus clinical criteria, to decide whether or not to initiate antibiotic
therapy (S-M).
Î For patients with suspected HAP/VAP, ATS and IDSA recommend using
clinical criteria alone rather than using C-Reactive Protein (CRP) plus
clinical criteria, to decide whether or not to initiate antibiotic therapy
(W-L).
Î For patients with suspected HAP/VAP, ATS and IDSA suggest using
clinical criteria alone, rather than using Modified Clinical Pulmonary
Infection Score (CPIS) plus clinical criteria, to decide whether or not to
initiate antibiotic therapy (W-L).
S, strong ; W, weak strength of recommendation
H, high; M, moderate; L, low; VL, very low quality of evidence
