Pneumonia

The “Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Pneumonia (PN). The definition of pneumonia (PN) is based on three types of criteria: radiological, clinical and microbiological.

Radiological

two or more serial chest x-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease, and at least one of the following (in patients without underlying cardiac or pulmonary disease one definitive chest x-ray or CT-scan is sufficient).

Clinical

fever> 38 °C with no other cause;

leukopenia (<4000 WBC/mm3) or leucocytosis (≥ 12 000 WBC/mm3);

and at least one of the following (or at least two if clinical pneumonia only = PN 4 and PN 5):

new onset of purulent sputum, or change in character of sputum (colour, odour, quantity, consistency);

cough or dyspnoea or tachypnoea;

suggestive auscultation (rales or bronchial breath sounds), rhonchi, wheezing;

worsening gas exchange (e.g. O2 desaturation or increased oxygen requirements or increased ventilation demand);

and (microbiological)

according to the used diagnostic method:

a) bacteriologic diagnostic test performed by:

• positive quantitative culture from minimally contaminated LRT (lower respiratory tract) specimen (PN 1):
  • bronco-alveolar lavage (BAL) with a threshold of > 104 CFU*/ml or ≥ 5 % of BAL obtained cells contain intracellular bacteria on direct microscopic exam (classified on the diagnostic category BAL);
  • protected brush (PB Wimberley) with a threshold of > 103 CFU/ml;
  • distal protected aspirate (DPA) with a threshold of > 103 CFU/ml;
• positive quantitative culture from possibly contaminated LRT specimen (PN 2):
  • quantitative culture of LRT specimen (e.g. endotracheal aspirate) with a threshold of 106 CFU/ml

b) Alternative microbiology methods (PN 3):

• positive blood culture not related to another source of infection;
• positive growth in culture of pleural fluid;
• pleural or pulmonary abscess with positive needle aspiration;
• histologic pulmonary exam shows evidence of pneumonia;
• positive exams for pneumonia with virus or particular germs (Legionella spp., Aspergillusspp., mycobacteria, mycoplasma, Pneumocystis carinii):
  • positive detection of viral antigen or antibody from respiratory secretions (e.g. EIA, FAMA, shell vial assay, PCR);
  • positive direct exam or positive culture from bronchial secretions or tissue;
  • seroconversion (e.g. influenza viruses, Legionella spp., Chlamydiaspp.);
  • detection of antigens in urine (Legionella spp.).

c) Others:

• positive sputum culture or non-quantitative LRT specimen culture (PN 4);
• no positive microbiology (PN 5).

Note:

PN 1 and PN 2 criteria were validated without previous antimicrobial therapy.

Link to European IC/HH Core Competencies

• Area 3. Surveillance and investigation of healthcare-associated infection (HAI)

References

• http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf