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Invited Commentary
May 2014

Chlorhexidine-Based Oral Care and Ventilator-Associated PneumoniaThe Devil in Disguise?

Author Affiliations
  • 1Department of Medical Microbiology, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
JAMA Intern Med. 2014;174(5):761-762. doi:10.1001/jamainternmed.2013.14017

Ventilator-associated pneumonia (VAP) is among the most frequently occurring infections among critically ill patients, and its development is associated with poor patient prognosis. As such, VAP has been an important topic of clinical research in intensive care medicine, pulmonology, infectious diseases, and clinical microbiology. Yet, after more than 30 years of clinical studies on diagnosis, treatment, and prevention, a myriad of uncertainties remain.

Among the many challenges that confront our efforts to effectively treat VAP is that there is currently no reliable gold standard for diagnosis. Diagnosis is essentially based on a combination of clinical symptoms, microbiological test results, and radiological interpretations. These criteria, even in combination, are highly subjective and have suboptimal specificity. Subjective diagnosis of VAP hampers unbiased evaluation of the efficacy of preventive measures in unblinded studies and increases the risk of assessment bias when VAP rates are used as a quality metric. Poor specificity of the diagnosis leads to unnecessary antibiotic use and its associated harms. Of note, the diagnostic approach with better specificity, ie, bronchoscopic procedures combined with quantitative microbiological cultures, is hardly used because it is invasive and expensive.

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