BACKGROUND Ventilator-associated pneumonia surveillance is used as a quality indicator due to concerns that some cases may be preventable and may contribute to mortality. Various surveillance criteria exist for the purposes of national reporting, but a large-scale direct comparison has not been conducted. METHODS A prospective cohort study applied two routinely used surveillance criteria for ventilator-associated pneumonia from the European Centre for Disease Control and the American Centers for Disease Control to all patients admitted to two large general intensive care units. Diagnostic rates and concordance amongst diagnostic events were compared. FINDINGS A total of 713 at-risk patients were identified during the study period. The European surveillance algorithm returned a rate of 4.6 cases of ventilator-associated pneumonia per 1000 ventilation days (95% confidence interval 3.1-6.6) and the American surveillance system a rate of 5.4 (3.8-7.5). The concordance between diagnostic events was poor (Cohen's Kappa 0.127 (-0.003 to 0.256)). CONCLUSIONS The algorithms yield similar rates, but the lack of event concordance reveals the absence of inter-algorithm agreement for diagnosing ventilator-associated pneumonia, potentially undermining surveillance as an indicator of care quality.

中文翻译：

---

呼吸机相关性肺炎的监测采用两种方法。

背景技术由于担心某些病例可能是可预防的并且可能导致死亡，因此将呼吸机相关性肺炎监测用作质量指标。为了进行国家报告，存在各种监视标准，但是尚未进行大规模的直接比较。方法一项前瞻性队列研究采用了欧洲疾病控制中心和美国疾病控制中心对呼吸机相关性肺炎的两种常规监测标准，用于接受两个大型普通重症监护病房的所有患者。比较了诊断事件中的诊断率和一致性。结果在研究期间共鉴定出713名高危患者。欧洲监视算法返回的比率为4。每1000个通气天6例呼吸机相关性肺炎（95％置信区间3.1-6.6），美国监测系统的发生率为5.4（3.8-7.5）。诊断事件之间的一致性差（Cohen's Kappa 0.127（-0.003至0.256））。结论该算法产生相似的发生率，但是缺乏事件一致性表明缺乏诊断呼吸机相关性肺炎的算法间协议，可能破坏监测作为护理质量的指标。