practice, a VAP diagnosis is most often based on positive cultures of tracheal aspirates, in combination with clinical symptoms. With a negative culture, the diagnosis of a clinical pneumonia was still possible. All patients ventilated invasively for two days (48 hours) or more, aged 16 years or older, and present in the ICU were included in the study. Successive ventilation periods of at least two days were recorded until a VAP occurred or until the end of follow‐up, 28 days after the start of each ventilation period. Each ICU admission was assigned a unique identifier that could not be used to link admissions at the patient level. Therefore, patients admitted more than once to the ICU were included as separate patients (termed “admissions”). For this manuscript, we considered only data from the first ventilation period of each admission. Data were recorded prospectively, with infection control professionals checking the patients and patient records in the ICU on average twice a week. Suspected VAPs were usually discussed with a dedicated radiologist or intensivist. Per admission were recorded: sex, age, admission and discharge dates of hospital and ICU, Apache II score, specialism, type of ICU and reason for end of follow‐up. Per ventilation period were recorded: start and end date, intubation site, intubation department, stress ulcer prophylaxis, post‐surgical ventilation, inhalation trauma, COPD, corticosteroid use (daily dose > 10 mg prednisone) and neutropenia (< 500 granulocytes). Per ventilation day were recorded: sedation score (Ramsay score[24] (see Table A in S1 File), feeding mode (>12 hours), oropharyngeal prophylaxis (SOD), intestinal prophylaxis, systemic antibiotics for selective digestive tract decontamination (ivSDD), systemic antibiotics (therapeutic, not for ivSDD) (ivAB), inhalation therapy (metered dose inhaler (MDI), jet nebulizer or none). Per infection were recorded: infection date, infection criteria and a maximum of three micro‐organisms. When a clinical or possible pneumonia was later followed by respectively a possible and/or (‘confirmed’) pneumonia (for the same infectious episode), the latter were recorded as final diagnosis. In this paper, we do not distinguish between these diagnostic categories. According to Dutch legislation, written consent from each individual patient was not required because the data from the PREZIES network is anonymized and was collected as a legal task of the National Institute for Public Health and the Environment. 62 Chapter 4
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