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• W3143145005 abstract "Champion raises several important questions about the spectrum of clinical and microbiologic criteria used to diagnose and treat ventilator-associated tracheobronchitis and pneumonia. Both ventilator-associated tracheobronchitis and pneumonia include clinical signs (elevated temperature, leukocytosis, and a purulent sputum) plus either a semi-quantitative endotracheal aspirate with at least moderate (+++) growth of a pathogen or quantitative endotracheal aspirate with ≥105 cfu/mL.1Nseir S. Di Pompeo C. Pronnier P. et al.Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome.Eur Respir J. 2002; 20: 1483-1489Crossref PubMed Scopus (138) Google Scholar, 2Nseir S. Favory R. Jozefowicz E. et al.Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.Crit Care. 2008; 12: R62Crossref PubMed Scopus (131) Google Scholar, 3Craven D.E. Lei Y. Ruthazer R. et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med. 2013; 126: 542-549Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar Ventilator-associated pneumonia can also be diagnosed by bronchoscopic or nonbronchoscopic bronchoalveolar lavage ≥104 cfu/mL or protected specimen brush sample with ≥103 cfu/mL. In contrast to ventilator-associated tracheobronchitis, ventilator-associated pneumonia requires a new and persistent infiltrate on chest radiograph or computer tomography scan. Unfortunately, the quality of chest radiographs used to diagnose ventilator-associated pneumonia may lack sensitivity early in infection and specificity for infiltrates that may be due to atelectasis, pulmonary emboli, congestive heart failure, or adult respiratory distress syndrome rather than ventilator-associated pneumonia. The low clinical pulmonary infection score values referred to by Champion in Table 1 were baseline values at study entry. The median clinical pulmonary infection score at the diagnosis of ventilator-associated pneumonia was 6, and 4 for ventilator-associated tracheobronchitis. Ventilated patients in our study were often elderly, with chronic underlying diseases, and at greater risk for immune senescence. In addition, the endotracheal tube acts as a one-way conduit for bacterial pathogens into the tracheobronchial tree, either by leakage around the cuff or intraluminal biofilm emboli. In addition, pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa have increased virulence, which increases the risk of progression from ventilator-associated tracheobronchitis to ventilator-associated pneumonia.1Nseir S. Di Pompeo C. Pronnier P. et al.Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome.Eur Respir J. 2002; 20: 1483-1489Crossref PubMed Scopus (138) Google Scholar, 2Nseir S. Favory R. Jozefowicz E. et al.Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.Crit Care. 2008; 12: R62Crossref PubMed Scopus (131) Google Scholar, 3Craven D.E. Lei Y. Ruthazer R. et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med. 2013; 126: 542-549Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar Diagnosing and treating ventilator-associated tracheobronchitis can prevent ventilator-associated pneumonia and improve patient outcomes.1Nseir S. Di Pompeo C. Pronnier P. et al.Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome.Eur Respir J. 2002; 20: 1483-1489Crossref PubMed Scopus (138) Google Scholar, 2Nseir S. Favory R. Jozefowicz E. et al.Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.Crit Care. 2008; 12: R62Crossref PubMed Scopus (131) Google Scholar, 3Craven D.E. Lei Y. Ruthazer R. et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med. 2013; 126: 542-549Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar In a study by Nseir et al,2Nseir S. Favory R. Jozefowicz E. et al.Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.Crit Care. 2008; 12: R62Crossref PubMed Scopus (131) Google Scholar ventilator-associated tracheobronchitis patients who were randomized to “early versus delayed” antibiotic therapy had a reduced rate of ventilator-associated pneumonia (13% vs. 47%, P < .05) and decreased mortality (18% vs. 47%, P < .05), as well as significantly reduced ventilator and intensive care unit days. These data underscore the need for a greater focus on diagnosing and treating ventilator-associated tracheobronchitis to reduce ventilator-associated pneumonia, and to improve patient outcomes,1Nseir S. Di Pompeo C. Pronnier P. et al.Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome.Eur Respir J. 2002; 20: 1483-1489Crossref PubMed Scopus (138) Google Scholar, 2Nseir S. Favory R. Jozefowicz E. et al.Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study.Crit Care. 2008; 12: R62Crossref PubMed Scopus (131) Google Scholar, 3Craven D.E. Lei Y. Ruthazer R. et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med. 2013; 126: 542-549Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar which should translate into reduced health care costs.4Unroe M. Kahn J.M. Carson S.S. et al.One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.Ann Intern Med. 2010; 153: 167-175Crossref PubMed Scopus (331) Google Scholar Does this Patient Have Ventilator-associated Tracheobronchitis?The American Journal of MedicineVol. 127Issue 8PreviewI have read with interest the brief observation from Craven et al, and would like to raise 2 important issues.1 They reported that 29% of patients with ventilator-associated tracheobronchitis progressed to ventilator-associated pneumonia. This figure compares favorably with previous studies.2 However, 68% of their patients developed early-onset pneumonia, which could not be preceded by ventilator-associated tracheobronchitis in such a short span of time—4 days. Only 9 patients (32%) developed late-onset ventilator-associated pneumonia, and 6 of them had previous ventilator-associated tracheobronchitis, making two thirds of late-onset ventilator-associated pneumonia patients with past ventilator-associated tracheobronchitis. Full-Text PDF" @default.
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