From: Diagnosis of ventilator-associated pneumonia: a systematic review of the literature
Johanson criteria | • Presence of a new or progressive radiographic infiltrate | ||
 | • Plus at least two of three clinical features: | ||
 |    - fever > 38°C | ||
 |    - leukocyto sis or leukopeni | ||
 |    - purulent secretions | ||
 | • Temperature | • Oxygenation (PaO2/FiO2) | • Tracheal secretions (score) |
 | - 0 point: 36.5–38.4 C | - 0 point: PaO2/FiO2 > 240 or ARDS | -0 point: < 14 |
 | - 1 point: 38.5–38.9 | - 2 points: PaO2/FiO2 < 240 and no evidence of ARDS | -1 point: > 14 |
 | - 2 points: < 36 or > 39 |  | -2 points: purulent sputum |
Clinical Pulmonary Infection Score (CPIS) | • Blood leukocytes (cells/μL) |  | • Culture of tracheal aspirate |
 | - 0 point: 4000–11000 |  | -0 point: minimal or no growth |
 | - 1 point: < 4000 or > 11000 |  | -1 point: moderate or more growth |
 | - 2 points: > 500 band forms |  | -2 points: moderate or greater growth |
 |  | • Pulmonary radiography |  |
 |  | -0 point: no infiltrate |  |
 |  | - 1 point: diffuse or patchy infiltrates |  |
 |  | - 2 points: localized infiltrate |  |
 | Total score of > 6 points suggests ventilator-associated pneumonia | ||
 | ARDS = acute respiratory distress syndrome | ||
Centers for Disease Control and Prevention (CDC) | • Radiology signs | • Clinical signs |  |
 | Two or more serial chest radiographs with at least 1 of the following: | At least 1 of the following: |  |
 | - new or progressi ve and persistent infiltrate | - fever (temperat ure > 38 C) |  |
 | - consolidation | - leukopeni a (< 4000 WBC) or leukocyto sis (> 12000 WBC) |  |
 | - cavitation | - altered mental status, for adults 70 years or older, with no other recognized cause |  |
 | • Microbiological criteria |  |  |
 | At least one of the following: | Plus at least 2 of the following:- |  |
 | - positive growth in blood culture not related to another source of infection | - new onset of purulent sputum, or change in character of sputum |  |
 | - positive growth in culture or pleural field | - increased respiratory secretions, or increased suctioning requirements |  |
 | - positive quantitati ve culture from bronchoal veolar lavage (> 104) or protected specimen brushing (> 103) | - new-onset or worsening cough, or dyspnea, or tachypnea |  |
 | - five percent or more of cells with intracellul ar bacteria on direct microsco pic examinati on of Gram-stained bronchoal veolar lavage fluid | - rales or bronchial sounds |  |
 | - histopathological evidence of pneumonia | - worsening gas exchange |  |
 |  | - increased oxygen requirements |  |