72-Hour Clinical Pulmonary Infection Score May Have Prognostic Value among Trauma Patients with Ventilator Associated Pneumonia

Gerard A. Baltazar; Amy Pate; Frederique Pinto; Akella Chendrasekhar

Volume : VIII, Issue : V, May - 2019

72-Hour Clinical Pulmonary Infection Score May Have Prognostic Value among Trauma Patients with Ventilator Associated Pneumonia

Gerard A. Baltazar, Amy Pate, Frederique Pinto, Akella Chendrasekhar

Abstract :

Background: Ventilator–associated pneumonia (VAP) is a common, serious nosocomial infection; reduction of morbidity and mortality is achieved by prompt diagnosis and early initiation of appropriate empiric antimicrobial therapy. While Clinical Pulmonary Infection Score (CPIS) on the day of VAP diagnosis has not been proven a consistently effective device, we postulate the CPIS 72 hours after VAP diagnosis may serve as a clinical prognostic indicator. The purpose of this study is to assess the potential value of CPIS in trauma patients with VAP.

Methods: We performed a retrospective chart review of 50 intubated trauma patients with VAP admitted to the intensive care unit (ICU) of an urban level–I trauma center from January–December 2013. Patients were consecutively identified via trauma registry, and data were abstracted on demographics; injury severity score (ISS); vital signs; laboratory values; microbiological cultures; ventilator settings; antibiotic therapy; time of VAP diagnosis; outcomes; and survival to discharge. We calculated modified CPIS at initial diagnosis and 72–hours post–diagnosis. Incomplete records were excluded from analysis.

Results: Forty–nine patients, 25 females and 24 males, with mean age of 66.1�5.2 years were analyzed. Overall mortality was 18.4% (n=9); mean ISS was 18.3�1.2; mean length of stay (LOS) was 20.7�3 days; mean ICU–LOS was 16.7�3.1 days; mean ventilator days was 15�3.2; mean day–1 CPIS was 5.8�0.5; and mean day–3 CPIS was 4.9�0.6. Multidrug resistant organisms (MDROs) were identified in 26 patients and associated with higher 72–hour CPIS (5.8�0.9 vs 3.7�0.7, p=0.025). 72–hour CPIS <6 was significantly associated with shorter LOS (16.8�3.1 vs 27.3�5.2 d), shorter ICU–LOS (12.4�2.9 vs 24.1�5.6 d), shorter duration of mechanical ventilation (10.8�3 vs 22.1�5.9 d), and earlier VAP diagnoses (hospital day 4.4�0.6 vs 7.1�1.4, p<0.001).

Conclusions: Initial CPIS calculations after VAP diagnosis have no clinical value. While not associated with survival to discharge, CPIS calculated 72 hours after VAP diagnosis may be used as a prognostic indicator for MDROs and improved short–term outcomes for trauma patients.