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How the modified Clinical Pulmonary Infection Score can identify treatment failure and avoid overusing antibiotics in
Paulo Sérgio Lucas da Silva1, Vânia Euzébio de Aguiar, Marcelo Cunio Machado Fonseca
1Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil.
Insights
The modified Clinical Pulmonary Infection Score (CPIS) can help identify ventilator-associated pneumonia (VAP) resolution or failure in children. A lack of CPIS score improvement by day three indicates potential treatment failure in high-risk pediatric VAP patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Respiratory medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in pediatric intensive care.
- The modified Clinical Pulmonary Infection Score (CPIS) is used in adults but lacks pediatric validation.
- Early identification of VAP resolution or treatment failure is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate a modified CPIS tool for defining VAP resolution in children.
- To assess the utility of the modified CPIS in identifying early treatment failure in pediatric VAP.
- To stratify pediatric VAP patients into risk groups based on modified CPIS scores.
Main Methods:
- A cohort of 70 mechanically ventilated children diagnosed with VAP was studied.
- Modified CPIS was measured at VAP onset, day 3, and day 5.
- Patients were categorized as low-risk or high-risk using a CPIS cutoff score of 6.
Main Results:
- High-risk patients (n=50) had a higher rate of positive cultures (64%) compared to low-risk patients (n=20, 10%).
- Adequate therapy led to significant CPIS score improvement by day 3 in most patients.
- A lack of CPIS score improvement by day 3 showed 100% sensitivity and 83% specificity for detecting treatment failure (AUC 0.92).
Conclusions:
- Serial modified CPIS measurements can guide VAP management in children.
- Low-risk pediatric VAP patients with negative cultures at day 3 may be candidates for shorter antibiotic courses.
- High-risk pediatric VAP patients not showing CPIS improvement by day 3 may be experiencing treatment failure.
Aim:
Although the modified Clinical Pulmonary Infection Score (CPIS) has been used to guide treatment decisions in adults with ventilator-associated pneumonia (VAP), paediatric studies are lacking. We assessed a modified CPIS tool to define VAP resolution and identify treatment failure at an early stage.
Methods:
We identified 70 mechanically ventilated children with VAP according to the Center for Disease Control criteria. Modified CPIS was initially measured at VAP onset and then three and five days afterwards. Children were defined as low risk or high risk based on a cut-off score of six.
Results:
There were 50 high-risk and 20 low-risk patients. Culture results were positive in 64% of the high-risk patients and just 10% of the low-risk patients. Patients on adequate therapy significantly improved their CPIS scores by day three, regardless of the likelihood of VAP. A lack of score improvement demonstrated sensitivity of 100% and specificity of 83% when it came to detecting treatment failure. The area under the receiver operating curve was 0.92.
Conclusion:
Serial modified CPIS measurements showed that low-risk patients with negative cultures at day three should be considered for a short course of antibiotics. In contrast, high-risk patients with no score improvement were potentially failing their treatment.
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