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31-03-2025 | Pneumonia | Original

A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Authors: Antoine Gaillet, Charles-Edouard Luyt, Jean-Francois Timsit, Karim Asehnoune, Francois Barbier, Matteo Bassetti, Lila Bouadma, Adrien Bouglé, Jean Chastre, Andrew Conway Morris, Jan J. De Waele, François Dépret, George Dimopoulos, Stephan Ehrmann, Santiago Ewig, Muriel Fartoukh, Arnaud Foucrier, José Garnacho-Montero, Sami Hraiech, Marc Leone, Demosthenes Makris, Ignacio Martin-Loeches, Dimitrios Matthaiou, Antoine Monsel, Philippe Montravers, Saad Nseir, José-Artur Paiva, Laurent Papazian, Garyfallia Poulakou, Pedro Póvoa, Jérôme Pugin, Alejandro H. Rodriguez, Antoine Roquilly, Damien Roux, Anahita Rouzé, Fabio Silvio Taccone, Antoni Torres, Jean-Ralph Zahar, Emmanuel Weiss, Keyvan Razazi

Published in: Intensive Care Medicine | Issue 3/2025

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Title: A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study
Authors: Antoine Gaillet
Charles-Edouard Luyt
Jean-Francois Timsit
Karim Asehnoune
Francois Barbier
Matteo Bassetti
Lila Bouadma
Adrien Bouglé
Jean Chastre
Andrew Conway Morris
Jan J. De Waele
François Dépret
George Dimopoulos
Stephan Ehrmann
Santiago Ewig
Muriel Fartoukh
Arnaud Foucrier
José Garnacho-Montero
Sami Hraiech
Marc Leone
Demosthenes Makris
Ignacio Martin-Loeches
Dimitrios Matthaiou
Antoine Monsel
Philippe Montravers
Saad Nseir
José-Artur Paiva
Laurent Papazian
Garyfallia Poulakou
Pedro Póvoa
Jérôme Pugin
Alejandro H. Rodriguez
Antoine Roquilly
Damien Roux
Anahita Rouzé
Fabio Silvio Taccone
Antoni Torres
Jean-Ralph Zahar
Emmanuel Weiss
Keyvan Razazi
Publication date: 31-03-2025
Publisher: Springer Berlin Heidelberg
Keywords: Pneumonia
Antibiotic
Published in: Intensive Care Medicine / Issue 3/2025
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-025-07856-7

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A consensus of European experts on the definition of ventilator-associated pneumonia recurrences obtained by the Delphi method: the RECUVAP study

Abstract

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