A Descriptive Study on Clinical Pulmonary Infection Score (CPIS) in Early Identification of Hospital-Acquired Pneumonia (HAP) Among Critically Ill Patients in a Tertiary Care Teaching Hospital

Abstract

INTRODUCTION:  Hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP) and healthcare-associated pneumonia (HCAP), occurs more than 48 hours after hospital admission and is often associated with multidrug-resistant (MDR) pathogens. Prompt and accurate diagnosis is critical, relying on clinical criteria such as fever, leukocytosis, purulent sputum, and new infiltrates on imaging, along with respiratory cultures to identify causative organisms. Empirical antibiotic therapy should be initiated early, targeting likely pathogens, but must be refined through de-escalation once culture results are available. This approach helps reduce the risk of resistance, minimizes unnecessary antibiotic use, and improves patient outcomes in healthcare settings. MATERIALS AND METHODS: The research was conducted within a tertiary intensive care unit (ICU), focusing on a cohort of 225 adult patients who were hospitalized for a duration exceeding 48 hours. Participants were selected using a purposive sampling method. Data collection involved observational techniques, utilizing validated assessment instruments that exhibited a strong internal consistency, evidenced by a Cronbach's alpha of 0.829. The data analysis employed Chi-square statistics to investigate associations among the variables studied. This methodological framework ensured robust findings and yielded valuable insights into clinical patterns and outcomes pertinent to patients in critical care environments. RESULTS: A study conducted on ICU patients revealed that a substantial 85.3% exhibited a low Clinical Pulmonary Infection Score (CPIS), characterized by moderate pyrexia and minimal respiratory secretions. In contrast, 14.7% of patients were classified as high-risk, demonstrating pronounced inflammatory responses and specific radiographic abnormalities. Analysis using Kendall's tau_b established a positive correlation between CPIS scores and the incidence of HAP. Among the cohort of 225 critically ill patients, those identified as high CPIS risk had a significantly elevated occurrence of HAP (p=0.001), underscoring the utility of CPIS as a robust predictive indicator for pneumonia risk in this population. CONCLUSION: The CPIS serves as an effective prognostic tool for the early identification of HAP in critically ill patients. In a study involving 225 ICU patients, a significant correlation was found between elevated CPIS scores and the development of HAP, highlighting its clinical utility. This correlation underscores the role of CPIS in facilitating timely medical decision-making by supporting early diagnostic and therapeutic interventions. Early identification of HAP through CPIS enables prompt initiation of appropriate antibiotic treatment, which is crucial in preventing complications-especially those related to multidrug-resistant organisms commonly encountered in intensive care settings. Moreover, the implementation of CPIS as part of routine patient assessment may contribute to improved patient outcomes, reduced duration of ICU stay, and overall enhancement of infection control measures. As a cost-effective and evidence-based scoring system, CPIS plays a vital role in optimizing care for high-risk, critically ill patients.