VAP: Do you know it when you see it?

Ask any infection control nurse, infectious diseases physician, or intensivist and they will tell you of the difficulty in trying to define and diagnose ventilator-associated pneumonia (VAP). This is because there are a number of other conditions that can mimic VAP. A new study in the Journal of Critical Care compares three VAP definitions to autopsy findings in 253 patients to determine the utility of the definitions. The CDC definition was not used, but is similar to one of the definitions applied in the study. None of the definitions performed well. The most sensitive definition (65%) had a specificity of 36%. On the other hand, one definition had a nearly perfect specificity (99%), but its sensitivity was dismal at 5%. The results of this study coupled with conventional wisdom should be taken as a warning that public reporting of VAP rates may mislead consumers, and other metrics for reporting should take precedence.