Comparison of VAP surveillance criteria
| Australian and New Zealand-developed checklist items | CDC/NHSN-developed three-tiered elements33 | |
|---|---|---|
| 1. PaO2/FiO2 ratio ≤300 mm Hg: decreased gas exchange in past 24 h (no cardiogenic pulmonary oedema/pulmonary disease) | Increased daily FiO2 increases of ≥0.2 or PEEP values ≥3 cm H2O)=VAC | |
| 4. Inflammatory response: ≥1 of the following (when no immunocompromise) | On or after day 3 of MV and within 2 calendar days of worsening oxygenation: | |
| A. New/persistent ↑ temperature ≥38°C | > 38°C or | and new antimicrobials started=IVAC |
| B. WCC ≤4 or ≥12 cells 109/L for 2 days | WCC ≤4 or ≥12 109/L | |
| C. Elevated C reactive protein (>100 mg/L) or procalcitonin (>2.5 ng/L) | NA | |
| 5. Microbial growth: >25 neutrophils per low power field in tracheal secretions | Purulent respiratory secretions containing >25 neutrophils per low power field=VAP | |
| 2. Sputum changes: increased volume, or colour changes (yellow or green) | NA | |
| 3. CXR infiltrates: new localised or diffuse infiltrates on single CXR (no cardiogenic pulmonary oedema/pulmonary disease) | NA | |
CXR, chest X-ray; IVAC, infection-related ventilator-associated complication; MV, mechanical ventilation; NA, not applicable; PaO2/FiO2 ratio, arterial oxygen tension divided by fraction of inspired oxygen; PEEP, positive end-expiratory pressure; VAC, ventilator-associated condition; VAP, ventilator-associated pneumonia; WCC, white cell count.