Ventilator-Associated Pneumonia (VAP) remains one of the more challenging infectious syndromes to diagnose. Many of the clinical findings we associate with VAP - fever, leukocytosis, changes in secretions, and radiographic abnormalities are nonspecific. At the same time, respiratory cultures from ventilated patients frequently identify organisms that may represent colonization rather than true infection. This makes VAP particularly well suited for diagnostic stewardship. Rather than focusing only on whether antibiotics should be started or stopped, diagnostic stewardship asks us to consider the entire diagnostic and treatment pathway.
This episode of The SHEA Podcast is hosted by Dr. Kimberly Claeys, a pharmacist and Associate Professor in the Department of Practice, Sciences, and Health Outcomes Research at the University of Maryland School of Pharmacy. Dr. Claeys is joined by two leading experts whose work has helped define the field of VAP Diagnostic Stewardship: Dr. Owen Albin and Dr. Anna Sick-Samuels.
Dr. Owen Albin is an Assistant Professor of Internal Medicine at the University of Michigan Medical School. His work focuses on improving the diagnosis and management of VAP through pragmatic diagnostic stewardship interventions, alveolar biomarkers that support personalized antimicrobial therapy, and patient-informed hierarchical composite end points for use in nosocomial pneumonia trials.
Dr. Anna Sick-Samuels is an Associate Professor of Pediatrics in the Division of Pediatric Infectious Diseases at Johns Hopkins University School of Medicine and Associate Hospital Epidemiologist at Johns Hopkins Hospital. Her work, including the BrighT STAR Respiratory Collaborative, has focused extensively on understanding, and improving respiratory culture utilization in children with artificial airways.
Links and Recommendations:
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2852334
- https://www.ovid.com/jnls/pccmjournal/fulltext/10.1097/pcc.0000000000003695~diagnostic-stewardship-of-endotracheal-aspirate-cultures-in
- https://www.sciencedirect.com/science/article/pii/S1198743X23006316?via%3Dihub
- https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/abs/asymptomatic-bacterisputia-rethinking-diagnostic-stewardship-in-pneumonia/3AD10C45254DA9421A23E15F6F901C11
- https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/healthcare-providers-consistently-overestimate-the-diagnostic-probability-of-ventilatorassociated-pneumonia/36A954D510AF12410491047130150A81
