375. CT Imaging in Ventilator Associated Pneumonia
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Ventilator-associated pneumonia (VAP) remains a challenging diagnosis in intensive care unit (ICU) patients. The role for CT imaging of the chest in VAP remains undefined. Here we describe the findings and the impact of CT scans in patients with VAP
Methods: Patients were included if classified by Infection Control nurses as VAP by CDC criteria guidelines. Cases were defined as patients with a CT of the chest within 7 days of the diagnosis; controls were other VAP patients. CT chest findings were classified into radiologic descriptions and locations of the involved lungs. Clinical Pulmonary Infection Scores (CPIS) were calculated. Statistics were performed with JMP software (SAS, Cary, NC).
Results: 65 patients (68% male, 74% Caucasian, 72% surgical, median age 63 [range 21-89]) were included. . In-hospital mortality was 42%. Of the survivors, only 1 patient was discharged home, all others to long-term care, and 34% were readmitted within 90 days. P. aeruginosa (27%), S. aureus (20%), and Klebsiella species (15%) were the leading organisms isolated in respiratory cultures. 22 patients (34%) had a CT chest. Atelectasis (68%) and simple effusions (55%) were the most common findings. Infiltrates or consolidations were seen in 45% of scans. The lower lobes were abnormal in all scans, and in 45% of scans the findings were restricted to the lower lobes. Data to calculate CPIS was available in 19/22 cases and 29/43 controls. Median CPIS score was 7 (range 4-12) vs. 6 (range 2-10) in cases vs. controls (p=0.02). Mortality amongst cases vs. controls was 41% vs. 42% (NS), and median length of stay (LOS) was 40 (range 11-178) vs. 33 (range 10-144) (NS). In multivariate analysis, which included age, gender, race, surgical vs. medical, CPIS, organism (S. aureus vs. gram-negative), CT scan was not associated with LOS or mortality.
Conclusion: CT abnormalities in VAP are varied and non-specific. In this series, CT imaging did not appear to have a significant role in the diagnosis or management of patients with VAP.
Steven Gordon, MD, FIDSA, Infectious Disease, Cleveland Clinic, Cleveland, OH, Ruffin Graham, MD, Cleveland Clinic Foundation, Cleveland, OH, Susan Rehm, MD, Cleveland Clinic, Cleveland, OH, Rudy Tedja, DO, David van Duin, MD, PhD and  R. Tedja, None..
R. Graham, None. 
S. J. Rehm,
Cubist Role(s): Investigator, Speaker's Bureau, Received: Research Support, Speaker Honorarium.
Pfizer Role(s): Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
S. M. Gordon, None. 
D. van Duin,
Wyeth Role(s): Speaker's Bureau, Received: Speaker Honorarium.

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