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Mortality and length of ICU stay did not differ despite a shorter duration (p = 0.0001) and lower cost (p = 0.003) of antimicrobial therapy in the experimental as compared with the standard therapy arm, and the development of antimicrobial resistance was lower among patients whose antibiotics were discontinued compared to those who received standard of care.Respiratory samples can be obtained using several techniques: The ATS/IDSA guidelines note that use of a bronchoscopic bacteriologic strategy has been shown to reduce 14-day mortality when compared with a clinical strategy (16.2 % vs. This study also demonstrated short-term mortality benefit in the BAL/PSB group.Hence, reliance on chest radiography for the diag¬nosis of VAP is not advisable.There is poor correlation between radiographic signs (alveolar infiltrates, air bronchograms) and histopathological diagnosis of pneu¬monia .
Early onset VAP is defined as pneumonia that occurs within 4 days and this is usually attributed to antibiotic sensitive pathogens whereas late onset VAP is more likely caused by multidrug resistant (MDR) bacteria and emerges after 4 days of intubation .Patients with a history of hospital admission for ≥ 2 days in the past 90 days, nursing home residents, patients receiving chemotherapy or antibiotics in the last 30 days and patients undergoing hemodialysis at out¬patient centers are susceptible to drug resistant bacteria [At the present time, there is no universally accepted, gold standard diagnostic criterion for VAP.Several clinical methods have been recommended but none have the needed sensitivity or specificity to accurately identify this disease .Clinical diagnosis of VAP can still miss about a third of VAPs in the ICU compared to autopsy findings and can incorrectly diagnose more than half of patients, likely due to poor interobserver agreement between clinical criteria .Analysis of these samples can be quantitative or qualitative.
One meta¬analysis of 13 studies evaluating the accuracy of CPIS in diagnosing VAP reported pooled estimates for sensitivity and specificity for CPIS as 65 % (95 % CI 61-69 %) and 64 % (95 % CI 60-67 %), respectively  demonstrated that the CPIS is an effective clinical tool for determining whether to stop or continue antibiotics for longer than 3 days.