Ventilator-associated pneumonia diagnosis

a prioritization exercise based on multi-criteria decision analysis

João Ferreira-Coimbra*, Carmen Ardanuy, Emili Diaz, Marc Leone, Gennaro De Pascale, Pedro Póvoa, Cristina Prat-Aymerich, Ricardo Serrano-Garcia, Jordi Solé-Violan, Rafael Zaragoza, Jordi Rello

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Clinical Microbiology and Infectious Diseases
ISSN0934-9723
DOI
StatusE-pub ahead of print - 25. okt. 2019

Fingeraftryk

Ventilator-Associated Pneumonia
Decision Support Techniques
Exercise
X-Rays
Patient Safety
Gram's stain
Blood Culture

Citer dette

Ferreira-Coimbra, João ; Ardanuy, Carmen ; Diaz, Emili ; Leone, Marc ; De Pascale, Gennaro ; Póvoa, Pedro ; Prat-Aymerich, Cristina ; Serrano-Garcia, Ricardo ; Solé-Violan, Jordi ; Zaragoza, Rafael ; Rello, Jordi. / Ventilator-associated pneumonia diagnosis : a prioritization exercise based on multi-criteria decision analysis. I: European Journal of Clinical Microbiology and Infectious Diseases. 2019.
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title = "Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis",
abstract = "The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique.",
keywords = "Biomarkers, Diagnosis, Imaging, MCDA, Microbiology diagnosis, Multicriteria decision analysis, VAP, Ventilator-associated pneumonia",
author = "Jo{\~a}o Ferreira-Coimbra and Carmen Ardanuy and Emili Diaz and Marc Leone and {De Pascale}, Gennaro and Pedro P{\'o}voa and Cristina Prat-Aymerich and Ricardo Serrano-Garcia and Jordi Sol{\'e}-Violan and Rafael Zaragoza and Jordi Rello",
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Ferreira-Coimbra, J, Ardanuy, C, Diaz, E, Leone, M, De Pascale, G, Póvoa, P, Prat-Aymerich, C, Serrano-Garcia, R, Solé-Violan, J, Zaragoza, R & Rello, J 2019, 'Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis', European Journal of Clinical Microbiology and Infectious Diseases. https://doi.org/10.1007/s10096-019-03720-x

Ventilator-associated pneumonia diagnosis : a prioritization exercise based on multi-criteria decision analysis. / Ferreira-Coimbra, João; Ardanuy, Carmen; Diaz, Emili; Leone, Marc; De Pascale, Gennaro; Póvoa, Pedro; Prat-Aymerich, Cristina; Serrano-Garcia, Ricardo; Solé-Violan, Jordi; Zaragoza, Rafael; Rello, Jordi.

I: European Journal of Clinical Microbiology and Infectious Diseases, 25.10.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Ventilator-associated pneumonia diagnosis

T2 - a prioritization exercise based on multi-criteria decision analysis

AU - Ferreira-Coimbra, João

AU - Ardanuy, Carmen

AU - Diaz, Emili

AU - Leone, Marc

AU - De Pascale, Gennaro

AU - Póvoa, Pedro

AU - Prat-Aymerich, Cristina

AU - Serrano-Garcia, Ricardo

AU - Solé-Violan, Jordi

AU - Zaragoza, Rafael

AU - Rello, Jordi

PY - 2019/10/25

Y1 - 2019/10/25

N2 - The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique.

AB - The aim was to provide global experts ranking on priorities in diagnostic tools for VAP in clinical practice. A multiple criteria decision analysis (MCDA) was performed to identify diagnosis tools for VAP diagnosis. Priority factors were identified after literature review. An international, multidisciplinary expert panel reviewed variables and ranked diagnostic tools. Experts from ten European hospitals participated. Regarding bedside clinical practices, seven required chest X-ray use in all patients, whereas six reported the use of blood cultures and endotracheal aspirate in all patients. Invasive techniques were routinely performed in seven sites. CRP, PCT, and Gram stains were performed in all patients by 5, 2, and 8, respectively. Impact on patient outcomes, safety, and impact on the decision to start antibiotic therapy were ranked as the top three relevant concerns (7.7/10, 7/10, and 6.9/10, respectively). Chest X-ray was ranked as the most important imaging technique to diagnose VAP (score 251.7). Apart from blood cultures, endotracheal aspirate culture was identified as the main collection method for the microbiological testing (scores of 274.8 and 246.8, respectively). Mini-BAL was the preferred invasive technique with a score of 208. Top three biomarkers were CRP (score 184.3), PCT (181.3), and WBC (166.4). Gram stain (192.5) was prioritized among laboratory diagnostic techniques. Using MCDA, it is recommended to perform a combination of diagnostic techniques including images (chest X-ray), culture of clinical specimens (blood cultures and endotracheal aspirate), and biomarkers (CRP or PCT) for VAP diagnosis at the bedside. Gram stain was ranked as the preferred laboratory technique.

KW - Biomarkers

KW - Diagnosis

KW - Imaging

KW - MCDA

KW - Microbiology diagnosis

KW - Multicriteria decision analysis

KW - VAP

KW - Ventilator-associated pneumonia

U2 - 10.1007/s10096-019-03720-x

DO - 10.1007/s10096-019-03720-x

M3 - Journal article

JO - European Journal of Clinical Microbiology & Infectious Diseases

JF - European Journal of Clinical Microbiology & Infectious Diseases

SN - 0934-9723

ER -