• Luis Felipe Reyes, Cristian C Serrano-Mayorga, Zhongheng Zhang, Isabela Tsuji, Gennaro De Pascale, Valeria Enciso Prieto, Mervyn Mer, Elyce Sheehan, Prashant Nasa, Goran Zangana, Kostoula Avanti, Alexis Tabah, Gentle Sunder Shrestha, Hendrik Bracht, Arie Zainul Fatoni, Khalid Abidi, Helmi Bin Sulaiman, Vandana Kalwaje Eshwara, Liesbet De Bus, Yoshiro Hayashi, Pervin Korkmaz, Ait HssainAliAMedical Intensive Care Unit, Hamad General Hospital, Doha, Qatar., Niccolò Buetti, Qing Yuan Goh, Arthur Kwizera, Despoina Koulenti, Nathan D Nielsen, Pedro Povoa, Otavio Ranzani, Jordi Rello, Conway MorrisAndrewADivision of Perioperative, Acute, Critical Care and Emergency Medicine, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambridge, UK. mozza@doctors.org.uk.Division of Immunology, Departmen, and D-PRISM Investigators.
• Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.
• Crit Care. 2024 Nov 22; 28 (1): 381381.

BackgroundPneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.MethodsThe D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.ResultsA total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.ConclusionsThis study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.© 2024. The Author(s).

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