Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings.

Autor: Rosenthal VD; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, USA. Electronic address: vdr21@med.miami.edu., Yin R; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA., Rodrigues C; Pd Hinduja National Hospital, and Medical Research Centre, Department of Microbiology, Mumbai, India., Myatra SN; Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India., Divatia JV; Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India., Biswas SK; Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India., Shrivastava AM; Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India., Kharbanda M; Desun Hospital, Department of Critical Care, Kolkata, India., Nag B; Desun Hospital, Department of Critical Care, Kolkata, India., Mehta Y; Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India., Sarma S; Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India., Todi SK; Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India., Bhattacharyya M; Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India., Bhakta A; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Gan CS; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Low MSY; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Kushairi MBM; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Chuah SL; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Wang QY; University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia., Chawla R; Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India., Jain AC; Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India., Kansal S; Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India., Bali RK; Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India., Arjun R; Kerala Institute of Med Sciences Health, Department of Critical Care, Trivandrum, India., Davaadagva N; Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India., Bat-Erdene B; Kerala Institute of Med Sciences Health, Department of Critical Care, Trivandrum, India., Begzjav T; Kerala Institute of Med Sciences Health, Department of Critical Care, Trivandrum, India., Basri MNM; International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan Pahang, Malaysia., Tai CW; International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan Pahang, Malaysia., Lee PC; International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan Pahang, Malaysia., Tang SF; Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia., Sandhu K; Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India., Badyal B; Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India., Arora A; Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India., Sengupta D; Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India., Tao L; Zhongshan Hospital, Fudan University, Department of Pneumonology, Shanghai, China., Jin Z; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.
Jazyk: angličtina
Zdroj: American journal of infection control [Am J Infect Control] 2023 Jul; Vol. 51 (7), pp. 751-757. Date of Electronic Publication: 2022 Nov 15.
DOI: 10.1016/j.ajic.2022.11.005
Abstrakt: Background: Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.
Methods: We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).
Results: 153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P<.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P<.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P<.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p<.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p<.0001); public (OR=1.84; 95%CI=1.49-2.26, P<.0001), and private (OR=1.57; 95%CI=1.29-1.91, P<.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P<.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P<.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P<.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P<.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P<.0001) showed the highest risk.
Conclusions: Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.
(Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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