CHEST Guidelines-Nature-(and-the-ICU)-Abhors-a-VACuum

Nature-(and-the-ICU)-Abhors-a-VACuum_chest

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The document, published in the December 2012 issue of CHEST, addresses two primary topics: advancements in diagnosing ventilator-associated pneumonia (VAP) and the long-term utility of TB interferon-gamma release assays (IGRAs).<br /><br />Firstly, the editorial comments on the challenges in diagnosing VAP, a common hospital-acquired infection that remains difficult to define due to the lack of a clear diagnostic standard. Researchers, including Wilkinson and colleagues, have found that neutrophil-derived proteases in the lung could be potential diagnostic markers for VAP. The U.S. Centers for Disease Control and Prevention is revising criteria for ventilator-associated events to improve diagnosis and reporting. However, there is concern that new classifications might lead clinicians to alter their treatment practices, potentially delaying vital antibiotic therapy.<br /><br />The editorial also questions the impact of new diagnostic categories, such as ventilator-associated complications (VACs) and infection-related VACs (IVACs). These categories aim to identify avoidable harms but may introduce unintended consequences, echoing past issues with catheter-associated bloodstream infections, where the frequency of blood cultures was reduced in efforts to lower CRBSI rates, possibly due to a behavioral shift among clinicians.<br /><br />Secondly, the document discusses the examination of IGRAs for latent TB infection, focusing on a study from South Korea. Health-care workers underwent monthly IGRA testing over a year, revealing frequent conversions and reversions of test results, indicating inconsistencies. These could arise from testing variability, new infections, or intermittent immune responses. Such studies enhance our understanding of IGRA reliability and offer insight into their performance when used repeatedly in TB screening.

Keywords

ventilator-associated pneumonia

VAP diagnosis

neutrophil-derived proteases

ventilator-associated events

TB interferon-gamma release assays

IGRA reliability

latent TB infection

ventilator-associated complications

infection-related VACs

hospital-acquired infection