• Jennie Johnstone, John Muscedere, Joanna Dionne, Erick Duan, Bram Rochwerg, John Centofanti, Simon Oczkowski, Francois Lauzier, John Marshall, Diane Heels-Ansdell, Nick Daneman, Sangeeta Mehta, Yaseen Arabi, Nicole Zytaruk, Peter Dodek, Neill K Adhikari, Tim Karachi, Emmanuel Charbonney, Henry T Stelfox, Arnold S Kristof, Ian Ball, Lori Hand, Rob Fowler, Ryan Zarychanski, Charles St Arnaud, Alyson Takaoka, James Kutsogiannis, Kosar Khwaja, Wendy Sligl, Osama Loubani, Jennifer Tsang, Daphnee Lamarche, Dawn Bowdish, Michael Surette, Deborah Cook, and Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group.
• University of Toronto, Toronto, Canada. Electronic address: jennie.johnstone@sinaihealth.ca.
• J Crit Care. 2023 Jun 1; 75: 154284154284.

IntroductionWe aimed to analyze intensive care unit (ICU)-acquired pneumonia according to 7 definitions, estimating associated hospital mortality.MethodsThis cohort study was nested within an international randomized trial, evaluating the effect of probiotics on ICU-acquired pneumonia in 2650 mechanically ventilated adults. Each clinically suspected pneumonia was adjudicated by two physicians blinded to allocation and center. The primary outcome was ventilator-associated pneumonia (VAP) informed by ventilation for ≥2 days, new, progressive or persistent infiltrate plus 2 of: temperature > 38 °C or < 36 °C; leukopenia (<3 × 10(Fernando et al., 20206)/L) or leukocytosis (>10 × 10(Fernando et al., 20206)/L); and purulent sputum. We also used 6 other definitions estimating the risk of hospital mortality.ResultsThe frequency of ICU-acquired pneumonia varied by definition: the trial primary outcome VAP (21.6%), Clinical Pulmonary Infection Score (CPIS) (24.9%), American College Chest Physicians (ACCP) (25.0%), International Sepsis Forum (ISF) (24.4%), Reducing Oxidative Stress Study (REDOXS) (17.6%), Centers for Disease Control (CDC) (7.8%), and invasively microbiologically confirmed (1.9%). The trial primary outcome VAP (HR 1.31 [1.08, 1.60]), ISF (HR 1.32 [1.09,1.60]), CPIS (HR 1.30 [1.08,1.58]) and ACCP definitions (HR 1.22 [1.00,1.47]) were associated with hospital mortality.ConclusionsRates of ICU-acquired pneumonia vary by definition and are associated with differential increased risk of death.Copyright © 2023. Published by Elsevier Inc.

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