CPIS

CPIS: Clinical Pulmonary Infection Score. Serial assessment tool for HAP/VAP diagnosis and therapy de-escalation decisions.

Diagnostic Matrix

Temperature (°C)

Blood Leukocytes (WBC)

Tracheal Aspirate

Oxygenation (PaO2/FiO2)

Radiographic Infiltrate

Sputum Culture

HAP/VAP Probability

Low probability (0)

Consider discontinuation of empiric antibiotics.

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Diagnosis of hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP)

Guiding the decision to initiate or discontinue empiric antibiotics in the ICU

Serial monitoring of treatment response in pulmonary infections

Stratifying the risk of pneumonia in patients with new pulmonary infiltrates

Section 2

Formula & Logic

The 6 Variables (Scores 0–2)

Temperature (°C): 36.5–38.4 (0); 38.5–38.9 (1); ≤36 or ≥39 (2)

Blood Leukocytes (WBC/mm³): 4000–11000 (0); <4000 or >11000 (1); + band forms (2)

Tracheal Aspirate: None/Rare (0); Abundant/Non-purulent (1); Abundant/Purulent (2)

Oxygenation (PaO2/FiO2): >240 or ARDS (0); ≤240 and no ARDS (2)

Radiographic Infiltrates: No infiltrate (0); Diffuse/Patchy (1); Localized (2)

Sputum Culture: Pathogenic growth ≤1+ or none (0); Pathogenic growth >1+ (1); + same on Gram stain (2)

Interpretation

Score ≤ 6	Low probability of pneumonia. Consider discontinuation of empiric therapy.
Score > 6	Suggestive of HAP/VAP. Completion of antibiotic course usually indicated.

Section 3

Evidence Appraisal

Validation

Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" samples.

Pugin J et al. • Am Rev Respir Dis.. 1991;143(5 Pt 1):1121-9. The original study defining the CPIS criteria.

Last Comprehensive Review: 2026

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