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To assess the predictive capacity for the diagnosis of ventilator-associated pneumonia (VAP) of serum procalcitonin levels before and on the day it is suspected. Single-center observational study in the intensive care unit of a teaching hospital. Consecutive patients whose serum procalcitonin levels were available on the day that VAP was clinically suspected (day 1) and at some time within the preceding 5 days (“before”). Serum procalcitonin levels were determined on day 1 and “before”. Among the 73 suspected episodes VAP was confirmed by quantitative bronchoalveolar lavage cultures in 32 and refuted in 41. Respective median “before” procalcitonin levels were 1.89 ng/ml (interquartile range 0.18–6.01) and 2.14 (0.76–5.75) in patients with and without VAP, but their respective median day-1 procalcitonin levels did not differ: 1.07 ng/ml (0.39–6.57) vs. 1.40 (0.67–3.39). On day 1 a 0.5 ng/ml procalcitonin threshold had 72% sensitivity but only 24% specificity for diagnosing VAP. Between “before” and day 1, procalcitonin increased in 41% and 15% of patients with and without VAP, respectively. Thus a procalcitonin rise on day 1, compared to its “before” level, had 41% sensitivity and 85% specificity for diagnosing VAP, with respective positive and negative predictive values of 68% and 65%. Crude values and procalcitonin rise had poor diagnostic value for VAP in this particular setting and thus should not be used to initiate antibiotics when VAP is clinically suspected. [ABSTRACT FROM AUTHOR]

Objective: We examined whether invasive lung-specimen collection-to-treatment times for intensive care unit patients with suspected ventilator-associated pneumonia (VAP) differ with to the work shift during which specimens were collected. We compared weekday day shifts and off-hours (from 6:30 p.m. to 8:29 a.m. the next day for night shifts, from Saturday 1:00 p.m. to Monday 8:29 a.m. for weekends, and from 8:30 a.m. to 8:29 a.m. the following morning for public holidays).Design and Setting: Single-center, observational study in the intensive care unit in an academic teaching hospital.Patients and Participants: 101 patients who developed 152 episodes of bacteriologically confirmed VAP.Measurements and Results: Of the 152 VAP episodes 66 were diagnosed during off-hours. Neither more bronchoscopy complications nor more inappropriate initial antimicrobial treatments for patients were observed between day and off-hour shifts. Indeed, the overall time from brochoalveolar lavage to antibiotic administration was shorter for off-hours than day-shifts due to shorter specimen collection-to-antibiotic prescription times, but antibiotic prescription-to-administration times were the same.Conclusions: An invasive strategy based on bronchoscopy to diagnose VAP was not associated with a longer time to first appropriate antibiotic administration when clinical suspicion of VAP occurs during off-hours. [ABSTRACT FROM AUTHOR]