Ventilator-associated tracheobronchitis, or VAP?

For one year, Dallas et al prospectively followed 2,060 intubated MICU/SICU patients at Barnes-Jewish, and concluded that 83 (4%) developed VAP and 28 (1.4%) got VAT, which was defined as fever and 100,000 CFUs in tracheal secretions, without an infiltrate. By their reckoning, a third of VATs progressed to VAPs. Pathogens (mainly MDR bacteria) overlapped. No differences in mortality were seen. In light of evolving "never event" reimbursement issues, the associated editorial's title is priceless: "VAT: Public-Reporting Scam or Important Clinical Infection?" CHEST 2011;139:513-518.