Gaillet Antoine, Luyt Charles-Edouard, Timsit Jean-Francois, Asehnoune Karim, Barbier Francois, Bassetti Matteo, Bouadma Lila, Bouglé Adrien, Chastre Jean, Morris Andrew Conway, De Waele Jan J, Dépret François, Dimopoulos George, Ehrmann Stephan, Ewig Santiago, Fartoukh Muriel, Foucrier Arnaud, Garnacho-Montero José, Hraiech Sami, Leone Marc, Makris Demosthenes, Martin-Loeches Ignacio, Matthaiou Dimitrios, Monsel Antoine, Montravers Philippe, Nseir Saad, Paiva José-Artur, Papazian Laurent, Poulakou Garyfallia, Póvoa Pedro, Pugin Jérôme, Rodriguez Alejandro H, Roquilly Antoine, Roux Damien, Rouzé Anahita, Taccone Fabio Silvio, Torres Antoni, Zahar Jean-Ralph, Weiss Emmanuel, Razazi Keyvan
Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.
Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
Intensive Care Med. 2025 Mar;51(3):506-517. doi: 10.1007/s00134-025-07856-7. Epub 2025 Mar 31.
There are recognized diagnostic criteria for a first ventilator-associated pneumonia (VAP) episode, but not for recurrences. Many randomized clinical trials (RCTs) have used the recurrence of VAP as a criterion for efficacy evaluation. Still, the different definitions used in RCTs make it difficult to compare studies. We aimed to develop a consensual definition of VAP recurrences and of the various types of VAP recurrences.
Thirty-six European experts constituting a multidisciplinary group of physicians (critical care, infectious diseases, microbiology) with special interest in the management of VAP were polled using the Delphi methodology.
After the completion of four iterations of the DELPHI method, 94% of experts agreed that the diagnostic criteria for a first VAP episode could also be used for recurrences, except for the radiological criterion, which not all the experts considered to be mandatory. Consensus was also reached regarding the definition of four distinct entities: relapse, persistent VAP, superinfection, and new-pathogen VAP. For relapse and persistent VAP, bacteriological findings were identical for different VAP episodes, whereas they differed for superinfection and new-pathogen VAP. The distinction between relapse and persistent VAP, and between superinfection and new-pathogen VAP depended on the timing of antibiotic treatment (before or after 48-72 h after the end of antibiotic therapy) and the clinical course. Microbiological criteria were proposed to facilitate the diagnosis of persistent VAP.
This consensus by European experts proposes four different VAP recurrence entities which should facilitate the harmonization of recurrence criteria for clinical practice and future studies.
对于首次呼吸机相关性肺炎（VAP）发作有公认的诊断标准，但对于复发情况却没有。许多随机临床试验（RCT）将VAP复发作为疗效评估的标准。然而，RCT中使用的不同定义使得研究之间难以比较。我们旨在制定一个关于VAP复发以及各种类型VAP复发的共识定义。
采用德尔菲法对36名欧洲专家进行调查，这些专家构成了一个对VAP管理特别感兴趣的多学科医生团队（重症监护、传染病、微生物学）。
在完成四轮德尔菲法后，94%的专家同意首次VAP发作的诊断标准也可用于复发情况，但放射学标准除外，并非所有专家都认为该标准是必需的。对于四个不同实体的定义也达成了共识：复发、持续性VAP、二重感染和新病原体VAP。对于复发和持续性VAP，不同VAP发作的细菌学结果相同，而对于二重感染和新病原体VAP则不同。复发与持续性VAP之间以及二重感染与新病原体VAP之间的区别取决于抗生素治疗的时间（抗生素治疗结束后48 - 72小时之前或之后）以及临床病程。提出了微生物学标准以促进持续性VAP的诊断。
欧洲专家达成的这一共识提出了四种不同的VAP复发实体，这应有助于临床实践和未来研究中复发标准的统一。
