Ventilator-associated pneumonia diagnosis: a prioritization exercise based on multi-criteria decision analysis

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Critical Care Medicine

Background:

• Ventilator-associated pneumonia (VAP) poses significant challenges in clinical practice.
• Accurate and timely diagnosis of VAP is crucial for effective patient management and outcomes.

Purpose of the Study:

• To establish global expert consensus on priority diagnostic tools for VAP.
• To rank diagnostic methods based on clinical relevance and impact on patient care.

Main Methods:

• A multiple criteria decision analysis (MCDA) was employed.
• An international, multidisciplinary expert panel from ten European hospitals participated.
• Literature review identified priority factors for diagnostic tool evaluation.

Main Results:

• Chest X-ray was the highest-ranked imaging technique for VAP diagnosis.
• Endotracheal aspirate culture and blood cultures were prioritized for microbiological testing.
• C-reactive protein (CRP) and procalcitonin (PCT) emerged as top-ranked biomarkers, with Gram stain favored for laboratory diagnostics.

Conclusions:

• A combined diagnostic approach including imaging (chest X-ray), specimen culture (endotracheal aspirate, blood), and biomarkers (CRP or PCT) is recommended for bedside VAP diagnosis.
• Gram stain is a prioritized laboratory technique for VAP diagnosis.